UnitedHealth Group-posted 7 months ago
$71,600 - $140,600/Yr
Full-time • Entry Level
Remote • Eden Prairie, MN
Insurance Carriers and Related Activities

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. We have a position open for a Business Analyst to 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 client's “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. This role can be based in Salt Lake City or is available to telecommuters. The Business Analyst role requires a highly flexible and adaptable analyst with the ability to handle periods of stress and/or heavy workloads. Solid experience as a Business Analyst or similar role is required, along with demonstrated experience with healthcare claims, or Medical /Drug/ reimbursement policies. The BA must have the ability to not only facilitate meetings but also negotiate and drive effective solutions by proactively review profiling system rules, using coding, policy, reimbursement, clinical, and claims background to determine which rules can be presented to the payer for new medical cost savings opportunities as well as generate innovate editing ideas that can be scaled across organizations. This position requires solid communication skills with ability to liaison between technical and non-technical personnel. The ability to adeptly navigate ever changing priorities is also a key skill of the BA. Additionally, the role requires the BA to become a Subject Matter Expert and provide end user training on the functionalized policies. The BA primarily works independently, however is also expected to work collaboratively across teams and the organization to support our client's needs and meet their affordability and saving's targets.

  • Support Optum medical Claims Editing System (CES) for AMS clients
  • Partner with Client Leader to establish and strategize how to achieve savings targets
  • Identify, research, develop, and size, new prepayment editing opportunities for use in Claims Editing System (CES) edit application for assigned healthcare payers
  • Proactively review profiling system rules, using coding, policy, reimbursement, clinical, and claims background to determine which rules can be presented to the payer for new medical cost savings opportunities
  • Present new edit concepts to clients during Governance meetings, effectively explaining the rule's intent, support, anticipated exposure, and influencing the client to adopt the rule
  • Execute the ‘Rule Approval' process
  • Generate innovative editing ideas that can be scaled across the organization
  • Stay current on client configuration and new CES functionality in order to recommend the most effective rule design
  • Conduct root cause analysis, including investigation into Knowledge Base updates, LCD updates, and rule logic defects, to recognize and remediate escalated issues
  • Interpret complex reimbursement language, policies, and methodologies
  • Define, create and maintain rule requirements
  • Acquire and maintain working knowledge of multiple platform specific knowledge, customer customizations, databases, file systems and architecture that support the CES application
  • Review quarterly Knowledge Base release to determine custom rule impact and maintenance needs
  • Building out non-proprietary and proprietary rule library: proactively share information with internal client teams
  • Present and evaluate solutions objectively and facilitate conflict resolution
  • Evaluate system changes for downstream system and/or organizational impacts
  • Build and maintain working relationships with stakeholders
  • Facilitate and/or assist with group meetings via Teams and telephonically, providing agendas and meeting minutes
  • Identify new opportunities to improve processes, customer relationships, while increasing our value to our client
  • Serve as a mentor to new Business Analysts, and routinely identify, develop, and share best practice experience with peers
  • 3+ years of Healthcare Industry experience (Healthcare reimbursement, claims adjudication, procedure/diagnosis coding knowledge)
  • 3+ years of Medicare/Medicaid policy guideline experience
  • 3+ years of experience performing Analysis and interpretation of business needs around client payment policies and translate into Business Requirements
  • 3+ years of proven ability to interpret technical requirements and business requirements while coordinating with technical staff to help drive solutions for our customers
  • 3+ years of proven ability to translate highly complex detailed clinical/technical solution concepts and articulate to technical and non-technical audiences
  • 3+ years of experience interfacing with Clients
  • 1+ years of experience interfacing at the Executive level
  • Proficient with MS Office Applications
  • Experience with CES, Claims Manager
  • Content Manager experience
  • Business Analyst software support experience
  • Training experience
  • Medical Coding experience or certified medical coder (AHIMA or CPC)
  • SQL or Oracle query experience
  • Comprehensive benefits package
  • Incentive and recognition programs
  • Equity stock purchase
  • 401k contribution
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