Data Mining Consultant - Optum SIU Consulting - Remote

Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together.

The Optum SIU Consulting Data Mining Consultant is responsible for the data analysis of external payers paid claims compared to the payer's reimbursement policies established by the payer.  The Data Mining Consultant will review paid claims data and recommend overpayment opportunity in which the provider was paid outside of the guidelines set forth in the payment policies of the payer or group.  The Data Mining Consultant will also recommend opportunities for analytic enhancements based upon changes made by the payer for improved identification of overpayment opportunity.  The Data Mining Consultant will also recommend opportunities for improvement of external payer reimbursement policies when appropriate.  

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.

Primary Responsibilities:

• Review monthly external payer, post pay data files to determine overpayment opportunity related to the reimbursement policies set forth by the payer  
• Communicate monthly outcomes to the external payer client via monthly collaboration and governance calls
• Direct the reporting and analysis team on new analytic opportunities to improve analytic outcomes and increased value to the external client
• Review payer reimbursement policies regularly to ensure proper adherence of appropriate payment activity and ensure appropriate reviews of the provider claim files
• Calculate appropriate overpayment expectations to the client
• Send monthly outcome files for appropriate billing and invoicing to the external payer
• Make recommendations on changes to the process that will drive efficiency and transformation

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:

• 3+ experience in health care claim processes, reimbursement policies, and coding practices
• 1+ years of experience in data analysis, analytic performance and medical claim overpayment calculation
• CPT & ICD coding experience
• Demonstrated written and verbal communications skills with experience in speaking with all levels of client leadership
• Demonstrated critical thinking, problem solving and analytical skills

Preferred Qualifications:

• Experience with health insurance billing/coding
• Demonstrated ability to prioritize and manage multiple tasks
• Proven ability to work in a team setting
• Proven excellent oral and written communication skills and presentation skills

*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 salary for this role will range from $72,800 to $130,000 annually 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.  

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.