BA/Project Lead – Code Set Maintenance

UCare offers Medicare, Medicaid, Individual and Family health plans – powered by the hardest working people in the industry.

Our people powered teams de-complicate, advocate and always go the extra mile to help our members.

We serve with integrity, compassion and commitment to do right by members, providers and government partners.

Above all, we come to work excited to provide members a path for the best health of their lives.

WORKING AT UCARE

Working at UCare is more than a career; it’s a mission.

A mission that defines us as professionals, unites us as an organization and shapes how we interact with our members and each other.

Employees join UCare and stay because of the opportunity to have a purpose-driven job.

Our strong culture has established UCare as a Star Tribune Top 150 Workplace for 12 consecutive years since the awards program began.

It’s a culture that embraces innovative ideas, strategic partnerships, and exemplary customer and provider experiences.

Working at UCare is being a part of a people powered team dedicated to making a real difference in the lives of our members and communities.

Work Location: Work from home, in the office or hybrid (in the office 3 or more days per week)

The health and safety of our employees, members, providers, and our community is our highest priority.

Therefore, all new employees are expected to be fully vaccinated against COVID-19 prior to starting at UCare, subject to limited exceptions such as for a sincerely held religious belief or for medical reasons.

Position Description

This position is responsible to manage the cross-functional UCare process for procuring, managing and maintaining claims billing code sets (e.g.

CPT, HCPCS) across impacted systems and tools (e.g.

HealthRules, Amisys, Optum product suite).

Act as UCare single point of contact for code set maintenance and management.

Collect and analyze code set and claim-related data and report findings and recommendations and manage any necessary actions.

Serve as liaison between the business and technical areas.

Collaborate with Stakeholders, CCO Teams and other department staff responsible for maintenance of all UCare applications/systems.

Communicate with Stakeholders via regular status reports and meetings to keep them up to date on progress of code set loads and updates.

Collaborate with business and technical teams to triage and troubleshoot code set management issues.

Ensure compliance with departmental, corporate, industry and government standards as specified.

· Responsible for ensuring quarterly Code updates are implemented in all required systems.

· Act as UCare single point of contact for CCO processes related to claims billing code set maintenance and management.

· Collaborate with CCO Leadership and stakeholders to identify and implement repeatable and sustainable process improvement efforts involving enhancements to code set maintenance end-to-end processes to increase process effectiveness and efficiency.

· Maintain a comprehensive, sustainable project management process and work collaboratively with teams to support code set maintenance and management goals and objectives.

· Facilitate regular meetings with Code Set team members and stakeholders to ensure data is loaded across systems and tools accurately, efficiently and timely.

Update status is communicated to all parties.

· Develop and implement process controls.

Establish and monitor measures to ensure process is meeting or exceeding internal and external SLAs.

· Manage code set grid – ensure that tasks/Service now requests are assigned to various teams as needed and checking to make sure they are completed timely.

· Responsible for monitoring claims reports to provide ongoing oversight of code-related, pended and processed claims, including ensuring any claim adjustments or reprocessing requests are submitted and completed.

Present updates and findings to stakeholder teams.

· Committee and/or work group representation as needed.

· Other projects and duties as assigned.

Education

Bachelor’s degree in business preferred; demonstrated experience may be considered in lieu of degree.

Required Experience

Three years of project management experience.Health Plan Operations.

Proven facilitation skills.

Strong analytical and critical thinking skills.

Demonstrate a broad understanding of how payments, benefits and authorizations are tied to codes to ensure accurate claims processing.

Preferred Experience

HealthRules knowledge and/or experience.Basic understanding of software development phases/life cycle.

Microsoft Project; Visio; SharePoint.

THE UCARE DIFFERENCE

The UCare difference is our people power – employees actively working on the behalf of our members to get them access to the health care they need.

We value and respect each individual’s ideas and contributions, and provide the freedom to grow both personally and professionally.

We are centrally located, and offer onsite education, equipment and wellness resources, and a myriad of volunteer activities.

If you’re looking for an inclusive environment that celebrates your people power, helps you build on your strengths and gives you the opportunity to truly make a difference, we invite you to apply.

As an Equal Opportunity/Affirmative Action Employer, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.