Business Operations Specialist

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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.                                                                   

As a Fortune 5 business, we’re one of the world’s leading healthcare companies. There are no limits here on the resources you’ll have or the challenges you’ll encounter. We have been supporting global healthcare systems from Ireland and the UK for more than 20 years, building a dynamic and diverse team of more than 2,100 talented individuals. With a continued record of growth and stability, we’re on the constant lookout for fresh talent to join our expanding teams. As a key member of the Risk and Quality Operations (RQO) team, you will play an important role in delivering UnitedHealth Group’s mission of helping people live healthier lives. The primary responsibility of this position will be ensuring accurate and complete member encounter data is provided to the Centre for Medicare and Medicaid (CMS). The Business Ops Specialist will be responsible for processing records which will be sent to CMS. As a Business Ops Specialist, you will be challenged to make recommendations as to how performance can be continuously improved. Join us! There’s never been a better time to do your life’s best work.

Schedule: Full-time position Monday – Friday with standard working hours.

Careers with Optum offer flexible work arrangements and individuals who live and work in the Republic of Ireland will have the opportunity to split their monthly work hours between our Letterkenny office and telecommuting from a home-based office in a hybrid work model. 

Primary responsibilities:  

• Ensure accurate, complete and timely submission of Risk Adjustment data
• Processing of encounter data records for transfer to CMS through multiple internal processes
• Develop and maintain relationships across the Submissions Team and the wider RQO and Risk, Quality and Network Solutions (RQNS) functions to facilitate collaboration and effective communication
• Work as part of a team to drive innovation and performance improvements which translate into improved customer outcomes and process efficiencies
• Develop and recommend performance and system improvements through user stories and defects
• Ensure requests and records are completed within stated deadlines and follow set policies and procedures
• Demonstrate understanding of standard operating procedures, policies, and processes and how those impact business partners’ operations
• Conduct investigations and/or submit documentation following internal and external policies, procedures, or requirements (e.g., CMS)
• Support audit requests as required for current job responsibilities within inbound and outbound file processing
• Make appropriate corrections to identified discrepancies (e.g., incorrect dates; data errors) within the scope of authority
• Proactively identify solutions and work with team to solve complex problems

You will 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 providing development for other roles you may be interested in.

Required qualifications:

• Experience in business/finance analysis/healthcare with foundational knowledge of Risk Adjustment
• Proficiency in Microsoft Office suite of products (Excel, PowerPoint etc.)
• Understanding of relevant computer systems and platforms (e.g.: reporting systems; financial systems; company shared drives; Knowledge Library)

Preferred qualifications:

• Knowledge of EDI/837 claim experience
• Healthcare data processing and SQL an advantage with 837 Claims and/or Encounter data experience beneficial
• Risk Adjustment experience

Soft Skills:

• High levels of drive, determination, and tenacity
• Ability to build and maintain relationships with colleagues
• Ability to perform well under pressure
• Ability to present information clearly, concisely and confidently to meet the needs of the audience
• Experience in acting independently with minimal supervision
• Ability to communicate analysis including trends and opportunities to business partners both written and verbally
• Ability to work independently and balance workload to meet customer expectations

Please note you must currently be eligible to work and remain indefinitely without any restrictions in the country to which you are making an application. Proof will be required to support your application.

All telecommuters will be required to adhere to the UnitedHealth Group’s Telecommuter Policy.

 

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

 

 

Diversity creates a healthier atmosphere: Optum is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to gender, civil status, family status, sexual orientation, disability, religion, age, race, and membership of the Traveler community, or any other characteristic protected by law. Optum is a drug-free workplace. © 2023 Optum Services (Ireland) Limited. All rights reserved.

 

 

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