Manager Business Systems Analysis
About The Position
As a Manager of Business Systems Analysis on the Encounter Operations Team at Optum, you will analyze and translate healthcare business, regulatory, and customer requirements into accurate, testable, and maintainable HIPAA transaction solutions. The role supports behavioral health claims and encounters, with a focus on ASC X12 transaction content, implementation guides, companion guides, data maps, acknowledgments, remittance outputs, and production readiness. You will lead cross-functional analysis initiatives, use approved digital tools to streamline analytical workflows, and partner with business and technical leaders to deliver high-quality healthcare solutions. The position can be performed remotely from anywhere within the U.S., subject to UnitedHealth Group’s Telecommuter Policy. The role includes interpreting HIPAA and ASC X12 requirements; defining business, functional, mapping, and validation requirements; developing and maintaining SQL-based data maps; researching and validating data; maintaining traceability and conducting audits; supporting Agile delivery; managing scheduled transaction or mapping jobs; and evaluating industry trends and technology solutions. You will also use enterprise-approved AI tools to streamline workflows, automate tasks, and support continuous improvement.
Requirements
- Bachelor’s degree or at least 4 years of equivalent healthcare data and business systems analysis experience in lieu of a degree.
- At least 4 years of experience working with medical or behavioral health claims, encounters, transaction processing, or related healthcare data.
- At least 4 years of hands-on SQL experience for data research, reconciliation, transformation, and validation.
- At least 2 years of business systems analysis, systems analysis, or related functional analysis experience.
- At least 2 years of experience creating or reviewing ETL mappings and working with relational databases, claims systems, encounter systems, or data warehouses.
- At least 2 years of experience with enterprise data warehouses, ETL technologies such as SSIS, or reporting tools such as SSRS or Tableau.
- Adherence to UnitedHealth Group’s Telecommuter Policy for telecommuters.
- Pass a drug test before beginning employment.
Nice To Haves
- Bachelor’s degree in Information Technology, Finance, Statistics, Business Administration, Healthcare Administration, or a related field.
- At least 2 years of experience analyzing HIPAA transaction guides, data elements, and usage requirements.
- Hands-on experience with 837, 277CA, and 835 transactions, including inspecting ASC X12 files and relating transaction content to system requirements.
- Experience with behavioral healthcare, Medicaid, and/or Medicare claims and encounter submission requirements.
- Working knowledge of healthcare claims platforms such as Facets.
- Experience with SQL Server Management Studio, transaction integrity tools, or advanced text-file analysis tools.
- Experience with regulatory reporting, data-quality controls, and customer-specific encounter submission requirements.
- Understanding of Agile software development practices and release lifecycle activities.
Responsibilities
- Apply HIPAA transaction guides, data elements, situational rules, and usage requirements, particularly for 837 claim/encounter, 277CA acknowledgment, and 835 remittance transactions.
- Translate ASC X12 implementation guides, federally mandated and customer companion guides, and proprietary specifications into business, functional, mapping, and validation requirements.
- Use enterprise-approved digital tools and automated capabilities to streamline analysis, improve data research, reduce manual work, and drive continuous quality improvement.
- Develop, review, and maintain source-to-target data maps for SQL-based repositories; use SQL for research, reconciliation, defect troubleshooting, and root-cause analysis.
- Maintain traceability among source requirements, business rules, mappings, test scenarios, defects, and transaction outputs; conduct mapping and code audits before production release.
- Act as a subject matter resource and liaison among business, customer, and technology teams; support Agile delivery by refining user stories, answering development questions, and keeping documentation aligned.
- Create, manage, and monitor scheduled mapping or transaction-generation jobs; investigate and resolve processing failures to support delivery timelines and operational quality.
- Evaluate industry trends, data standards, and technology solutions to inform solution design, optimization, and technology innovation.
- Leverage enterprise-approved AI tools to streamline workflows, automate tasks, and drive continuous improvement.
Benefits
- Comprehensive benefits package, subject to eligibility requirements.
- Incentive and recognition programs, subject to eligibility requirements.
- Equity stock purchase, subject to eligibility requirements.
- 401(k) contribution, subject to eligibility requirements.
- Career development opportunities.
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What This Job Offers
Job Type
Full-time
Career Level
Manager
