ABOUT UCARE

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 200 Workplace for 14 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.

Position Description

This position is responsible to design, configure, test, implement and maintain HealthRules Payor pricing, claims and/or benefit configuration, according to business requirements, to support accurate and efficient claims processing and data reporting for UCare. Investigate and resolve configuration-related provider, member and claim processing issues and assist other departments in understanding HealthRules Payor configuration. Lead complex configuration projects, annual readiness configuration and/or care system contract implementations.

• Develop and maintain an understanding of current UCare HealthRules Payor configuration, contracts, products, and policies.

• Analyze, configure, test, implement and maintain HealthRules Payor configuration to support changes in contracts, products, benefits, legislation, and UCare policies and procedures, ensuring timely maintenance and updates of configuration.

• Test, implement and train on new HealthRules Payor and third party product releases, modules and updates.

• Assist in the development of test scenarios for changes and/or projects. Manage the timely resolution of open testing bugs and issues. Develop and monitor post production audit reports to ensure the intent of change and/or project requirements is being met.

• Develop and maintain configuration documentation and communicate changes, as appropriate.

• Work with Business Analyst, Technical Business Analyst, UAT and QA to create detailed functional requirements that support and align to business requirements and testing scenarios.

• Research and respond to service requests in a prompt and timely manner and update or build configuration in HealthRules Payor as needed.

• Recommend and draft new and updated procedures to maximize the use of HealthRules Payor and other third party products to improve efficiency.

• Develop and maintain good working relationships with the staff of other departments including Provider Relations & Contracting, Healthcare Economics, Provider Assistance Center, Government Relations, Product, and Coverage Policy.

• Inform leader and peers of changes that will impact UCare. Research and recommend methods to improve or implement necessary changes in a prompt and efficient manner.

• Other projects and duties as assigned.

Education

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

Required Experience

Three years of configuration experience or a combination of claims processing, healthcare system operations, data analytics and configuration. Must possess working knowledge of managed care operations, system development and testing. Microsoft Office proficiency.

Preferred Experience

Experience using Business Objects. Ability to build and maintain relationships across the enterprise. Strong knowledge of government programs, regulations and benefits. Previous experience with CMS, DHS or payer reimbursement methodologies and /or payment policies. Knowledge of or experience with Optum Claims Editing System (CES) and Axiom TranSend.

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 .