Senior Business Systems Analyst - CES

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.  

As a Research Analyst you will support the Optum Application Managed Services (AMS) Team. The AMS team engages in long term commitments and partnerships.
AMS provides full service operation to our clients with a proactive approach to business communication, growth and problem resolution. The AMS team partners with health plan clients to become an extension of their organization. The highly seasoned staff is dedicated to managing Claims Edit System (CES) as well as looking at where CES fits in the clients "Ecosystem". AMS provides services that will help provide long term benefit for the client, not only direct savings and increased revenue but also savings in process, manual effort and other operational areas.

The Research Analyst role requires a highly flexible and adaptable individual to work independently, yet collaboratively, across various Optum teams and client organizations. The Research Analyst must have the ability to research complex issues and drive resolution. The successful RA candidate will have strong communications skills and the ability to liaison between technical and non-technical personnel. The ability to adeptly navigate ever changing priorities is also a key skill of the Research Analyst.

Primary Responsibilities:

• Support Optum medical claims editing system (CES) for AMS clients
• First point of contact for issues, questions and adhoc requests from our clients
• Triage & document in Salesforce all incoming client issues
• Research and/or troubleshoot unique and complex problems, perform root cause analysis, identify and implement resolutions
• Communicate 'known problems' to the CES team
• Acquire and maintain working knowledge of multiple platform specific areas, customer customizations, databases, file systems and architecture that support the application
• Facilitate and or assist with group meetings via Microsoft Teams and telephonically as needed
• Clinical query submission; Work with clinical development team to provide clinical rationale for system edits
• Defect Tracking; Work with users, system analysts, clinical developers and programmers to identify and remediate defects within CES functionality
• Configuration Changes in client environments
• Loading of LCD/NCD data files in client environments
• Evaluate system changes for downstream system and/or organizational impacts

• Work independently and be self-driven, but collaboratively in a team environment

• Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

Required Qualifications:

• 3+ years of experience with healthcare reimbursement, claims, procedure and diagnosis coding knowledge
• 3+ years of experience analyzing and solving customer problems
• 3+ years of experience analyzing client business needs to help drive solutions
• Proficiency with MS Office applications
• Proven exceptional interpersonal, verbal and written communication skills
•  Proven ability to manage multiple priorities and execute deliverables on time
•  Proven to be highly motivated and innovative, with the ability to work as part of a high performing team as well as independently

Preferred Qualifications:

• Certification in Coding (AHIMA or CPC)
• Software support experience
• Experience with CES or Claims Manager Products

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.

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