Advisory Services Senior Consultant - Remote

UnitedHealth Group•Eden Prairie, MN

7h•Remote

About The Position

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. By delivering solutions across spectrums of health care Optum is focused on our aspiration of improving experiences and outcomes for everyone we serve while reducing the total cost of care. In support of this, OptumInsight's purpose is to connect the health care system with trusted services, analytics and platforms that make clinical and administrative processes valuable, easy, and efficient for everyone OptumInsight provides analytics, research, consulting, technology and managed services solutions to hospitals, physicians, health plans, government agencies, life science companies, and other industry partners. In addition to our many commercial clients, OptumInsight capabilities and technologies are leveraged by OptumHealth, OptumRx and our sister company UnitedHealthcare. This position will be responsible for scoping, analysis, and delivery of analytics-oriented projects. Qualified candidates will possess a solid understanding of value-based payment and reimbursement methodologies and concepts that include APC, DRG, Per Diem, RBRVS, etc. Candidates should also have experience working with large medical claims datasets and be familiar with how to quickly identify issues with claims data quality. Candidate should be able to work independently and collaboratively in a matrixed team environment and possess solid critical thinking solution oriented skills. 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. 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.

Requirements

4+ years working with and analyzing medical health care data. Must be familiar with claim structure, data components and relationships that contribute to reimbursement. Pharmacy health care data is a plus
4+ years of solid SQL experience, preferably in MS SQL Server environment with knowledge of database maintenance, ETL, and experience with complex scripts
2+ years of experience with CMS Prospective Payment System (PPS) frameworks and reimbursement methodologies (e.g., DRG, APC, RBRVS, Per Diem), with solid knowledge of Commercial, Medicare, and/or Medicaid payment models
2+ years of proven experience with utilizing Artificial Intelligence to either streamline processes, improve a product/solution or similar
Proven solid written and verbal communication skills, with keen attention to detail and the ability to effectively present complex information to both technical and executive audiences

Nice To Haves

Experience with Python, Apache Spark, Cloud Computing and Databricks
Intermediate to Advanced Proficiency level of skill in Excel. Knowledge of VBA
Proven excellent data quality assessment skills. Must be able to leverage knowledge of UB and CMS claims to quickly identify problems within a submitted claims dataset
Proven excellent data analysis skills and a demonstrated ability to assess patterns, trends, and behaviors within large health care claims populations
Proven ability to work independently while proactively identifying issues and developing effective solutions

Responsibilities

Assist in the maintenance and support of the Normalized Pricing product, including product releases, updates, and collaboration with different teams to synchronize the algorithm across various platforms
Works with clients to coordinate data requests and submissions with clients
Provide data analytics processing support according to project specifications either individually or through collaboration with other subject matter experts
Provide support to customers for Normalized Pricing, including supporting product implementation and consultation, coordinating data requests and submissions, making recommendations, performing pricing, analyzing, and explaining results, identifying issues, and providing solutions
Compile, structure, and present results to customers through spreadsheet reports and additional analytical deliverables, including data visualizations, while explaining key findings, insights, and implications
Partner with applicable stakeholders to identify and implement operational efficiencies and assess the operational impact of changes within defined solutions (e.g., changes to policies/procedures, compliance with applicable legal/regulatory requirements, additional requirements)
Engage in the development of new products and solutions to enhance revenue growth opportunities including using AI to streamline processes and work efforts
May require on occasion working nights and weekends for client support and/or production releases