Encounter Data Sr. Business Analyst - Remote

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.

Have you been working with Encounter Management systems and/or Claims Payment systems and their associated HIPAA X12 EDI 837 Claims and 277 Acknowledgment transactions?  Are you a strategic, data-driven analyst who not only solves problems at their root but builds sustainable solutions to prevent them from happening again?

We're seeking an experienced senior analyst who will guide end-to-end improvements in encounter data operations, using technical strategies to optimize efficiency in the Finance department.

You will use your existing Microsoft SQL skills to write queries to generate reports according to health plan requirements. Must be proficient in developing ad hoc scripts to support evolving business needs.

Collaborates directly with internal and external partners to review and solve errors to meet service level agreements. Responsible for the timely analysis and resolution of rejected encounters for both clearinghouse and direct encounter submissions. Ensures all corrections align with health plan industry standards and guidelines established by CMS and DHCS.

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: 

• Monitor daily end-to-end encounter submissions from in-house system to health plans
• Correct rejected encounters in accordance with CMS and DHCS claims processing guidelines and industry standards
• Write and generate reconciliation reports as required by health plans
• Proficient in developing ad hoc scripts to provide insight and analysis for leadership
• Proactive in analyzing trends of rejected encounters; conducting root cause analysis and scope to prioritize escalations 
• Manage key relationships with health plans, clearinghouses, and internal stakeholders to drive effective prevention, resolution, and escalation of encounter errors
• Resource for EDI validation as required for 837 resubmissions or user testing
• Prepare and update department documentation and training materials
• Lead special projects and additional responsibilities as needed

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 Microsoft SQL query development and reporting
• 2+ years of experience within the healthcare data environment - (e.g. encounters, eligibility, provider, claims)
• EDI 837 production support and maintenance experience including editing and correcting X12 837 transactions for resubmission to trading partners
• EDI testing and validation experience 
• Experience using Microsoft Office, Excel (e.g. dashboards, pivot tables, formulas, v-lookup)
• Ability to travel up to 10%

Preferred Qualifications: 

• Proven knowledge about importance of encounter data reporting and impact on revenue
• Demonstrated understanding of claims billing cycle and reimbursement process a plus
• Based in Southern California

*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.

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.    

OptumCare 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.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment