Regulatory Affairs Consultant

About the position Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. Optum, part of the UnitedHealth Group family of companies, is looking for a Regulatory Affairs Consultant - Remote. This person will serve as a subject matter expert in the area of Medicare, Medicaid and Commercial reimbursement, assisting others in the design, development, and support of software to edit claims and calculate payment. The leader in prospective payment system (PPS) reimbursement, Optum® EASYGroup™ keeps up with ever-changing PPS rules, content, and ongoing regulations for our clients. EASYGroup™ creates editing, grouping and reimbursement software used nationally by Medicaid Managed Care Organizations, Medicare Advantage Payers, and hospital providers. EASYGroup is a portable software library offering more than 50 federal, state and payer-specific prospective payment systems — the most comprehensive PPS solution available today. Its sophisticated technology allows hospital and physician contracts related to federal and state reimbursement to be effectively maintained, updated, and negotiated.

Responsibilities

• Track and analyze all new and existing regulatory requirements pertaining to Medicare, Medicaid, and Commercial reimbursement, based on assigned products
• Prepare summaries and analysis of the relevant regulatory updates, comparisons to existing or proposed regulations and detailed descriptions of the operational requirements and affected products
• Enter the updates and changes to the regulations and rules, along with any data elements into a data base used to track the updates
• Maintain and update all applicable software on your computer
• Maintain a working knowledge of the requirements for assigned products
• Work independently to analyze and manage regulatory content for assigned products
• Complete testing of software for Medicaid States/Product releases
• Correspond with various entities, such as Medicare, TRICARE, and state agency contacts. Ensure that the responses are sent to the appropriate team(s) and that follow ups are sent as needed
• Assist clients with various regulatory and product inquiries, via Salesforce tickets, client meetings, and email exchange
• Meet with key accounts, business partners, and potential customers, explaining the regulatory environment, discussing their requirements, and explaining how we can meet their requirements with our products and services
• Help determine product direction for existing products and services, and design new products and services, based on national and regional prospective payment initiatives
• Evaluate new health care programs or benefits from Medicare, Medicaid, and commercial payers
• Work with product managers to identify areas of product growth based on industry trends
• Provide assistance, leadership and mentoring for other Regulatory and Optum staff

Requirements

• 3+ years of project management experience, including experience simultaneously managing multiple projects
• 3+ years of experience with state, HIPPA, and other federal privacy laws
• 3+ experience building relationships across business groups internally and outside the organization (regulatory agencies)

Nice-to-haves

• Experience with the Optum PPS Software
• Experience with the reimbursement methodology for the various Optum PPS software products
• Experience maintaining and updating work laptop with all applicable Optum software

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution

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