Business Analyst – Medicare Compliance

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.

 

The Business Analyst, Medicare Compliance – Infusion RCM is a key individual contributor responsible for ensuring adherence to Medicare regulations and internal compliance standards across the infusion revenue cycle. This role provides subject matter expertise in Medicare billing, collections, documentation, audit readiness, and partners cross-functionally with operations, billing, coding, and compliance teams to mitigate risk and drive regulatory excellence.

 

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

 

Primary Responsibilities:

• Serve as the primary point of contact for Medicare regulatory updates and audit readiness
• Monitor and enforce compliance with CMS guidelines, MAC updates, and regulatory changes impacting infusion services
• Conduct internal audits and reviews of claims, documentation, and billing practices to ensure compliance with Medicare requirements
• Provide training and oversight to ensure consistent application of Medicare policies across RCM teams
• Identify compliance risks and recommend corrective actions or process improvements
• Collaborate with internal audit and legal teams to address findings and implement corrective actions
• Support external audits and respond to Medicare inquiries, ADRs, and appeals
• Maintain documentation of compliance activities, findings, and resolutions
• Partner with legal, compliance, and quality teams to ensure alignment with enterprise policies and regulatory expectations

 

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:

• 5+ years of experience in healthcare revenue cycle management, with at least 2 years focused on Medicare compliance
• Experience with audit processes, denial management, and regulatory reporting
• Demonstrated solid knowledge of Medicare billing rules, NCDs/LCDs, and infusion therapy coding
• Demonstrated excellent analytical, communication, and documentation skills
• Proven ability to work independently and manage multiple priorities in a fast-paced environment

 

Preferred Qualifications:

• Experience with infusion pharmacy or home infusion billing 
• Familiarity with Optum or UnitedHealth Group systems and compliance frameworks 

 

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

 

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you’ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable

 

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 down early due to volume of applicants.

 

 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: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and 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.  

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