Job Description

Do you love the excitement of a fast-paced, high-growth organization? If so, a career at Optum, part of the UnitedHealth Group family of businesses will allow you to serve almost all dimensions of the health system from those who diagnose and treat patients to those who pay for care, deliver health services and those who supply the cures. Optum brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. Join us and learn why there is no better place to do your life's best work.(sm)

As an Analytic Development Consultant, you will be responsible for supporting the identification, development, and presentation of new medical cost savings opportunities on behalf of our clients. This position will support assessment of new opportunities based on data insights leveraging tools, policies, industry trends, and by soliciting input from a broad network of experts across Optum. This position requires a strong analytical skillset, data analysis and healthcare claims experience (HCFA/UB) to detect incorrectly paid claims for multiple segments (Medicare, Medicaid, Commercial) and claim platforms.

You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

* Researching and developing potential claim overpayment hypotheses
* Utilizing data mining tools (i.e. SQL, Access, Excel) in order to analyze data to support of their hypothesis
* Researching policies, coding guidelines, and regulations that would support the hypothesis being developed
* Developing Business Requirement Documentation in a clear, concise, and comprehensive manner
* Clearly communicate concept to business partners/clients and be able to appropriately respond to questions relating to the logic utilized within hypothesis testing, documentation, and the analytic
* Performing quality checks for claim overpayment results and monitoring analytic performance
* Present research findings in a clear and concise manner utilizing data reports and summaries to support concepts

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

* 2+ years of experience in healthcare (billing, coding, auditing claims)
* 1+ years of experience conducting analysis on large data sets
* 1+ years of experience with claims processing or adjudication systems (Such as UNET, COSMOS, Facets, Diamond, etc. or provider billing / coding knowledge on Professional and Facility claims)
* An understanding of healthcare payment methodologies, policies, and coding are necessary
* Maintains working knowledge of coding standards, billing rules and regulations and knowledge of procedure and diagnosis codes (CPT, ICD10 coding, HCPCS, APC and DRGs)
* Strong computer skills: MS Access, Excel, Word, PowerPoint
* Excellent critical thinking and problem-solving skills
* Strong communication and negotiation skills
* Flexibility and ability to handle multiple priorities at the same time
* Ability to think outside of the box and breakdown complex problems into individual root causes
* Self-managed, self-starter with the ability to support multiple concurrent projects and meet tight delivery timelines
* If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained

Preferred Qualifications:

* Advanced degree in health care or medical field
* 1+ years of SQL experience (PLSQL, Teradata, MySQL)
* Technical Writing and/or Business Requirement Documentation experience
* Coding Certification through AAPC or AHIMA
* Knowledge of statistical methods used in the evaluation of healthcare claims data
* Proficiency with SQL coding and ability to run test queries to ensure viability of concepts under review
* Typing speed of at least 50 WPM including ten-key

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

Colorado Residents Only: The salary range for Colorado residents is $64,800 to $116,000. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy

Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Job Keywords: Healthcare, billing, coding, auditing, claims, data analysis, claims processing, UNET, COSMOS, Facets, Diamond, SQL, PLSQL, Teradata, MySQL, AAPC, AHIMA, telecommute