Provider Data and Claims Consultant – Remote

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 telecommute* from anywhere within United States as you take on some tough challenges.

 

Primary Responsibilities:

• Support the behavioral health member and provider operations team by working within the CSP Facets Pricing Integrity Audits and Provider Pick Integrity programs
• The CSP Facets Pricing Integrity Audits program is primarily driven by a rules-based audit that assesses the quality of provider pricing data based on demographic and contractual systems data
• Work in this space as part of a workgroup that completes existing market audits including market analysis, reporting, and remediation
• The Provider Pick Integrity program is rooted in a rules-based decision engine that is designed to aid in the process of selecting provider records for claims payment in non-standard situations
• Perform as part of a workgroup to assess provider pick job aids to make rules engine development recommendations and complete development UAT of those recommendations while also acting as an operational backup to the program’s ongoing operation
• This role will be heavily dependent on legacy, widely distributed applications (Microsoft Access, Excel, SQL Server, etc) but also will be geared toward adopting new technological options

 

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

Required Qualifications:

• 3+ years of data analysis and/or audit experience within the healthcare industry
• 3+ years of claims analysis and/or claims audit experience
• Advanced level understanding of UHG provider data, including at least two of the following: NDB, OHBS Facets, CSP Facets
• Experience with 2 of the following:
  • Leading cross-functional workgroups
  • Claim payment and pricing
  • Defining detailed requirements for macros, automation, or user tools
  • Writing SOPs (standard operating procedure documents)
• Intermediate level proficiency with Microsoft Excel

 

Preferred Qualifications:

• Experience working directly with provider data in Facets (OHBS and/or CSP)
• Experience with Optum Behavioral Health
• Experience with table structures in Facets
• Experience in an operational role at UHG
• Experience in working in a fast-paced environment with rapidly changing priorities
• Intermediate expertise with SQL
• Intermediate expertise with Python
• Intermediate expertise with Microsoft Access
• Demonstrated ability to gather, analyze, interpret, and present data to various audiences
• Demonstrated ability to communicate ideas clearly and concisely verbally, written or in presenting to groups
• Demonstrated ability to manage a self-directed workload with a clear understanding of workflow and team dependencies
• Proven time / project management, problem solving, organization and analytical skills

 

Telecommuting Requirements:

• Required to have a dedicated work area established that is separated from other living areas and provides information privacy
• Ability to keep all company sensitive documents secure (if applicable)
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

 

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy 

 

The salary range for this role is $71,600 to $140,600 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

 

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come

 

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.   

 

 

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

 

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