Senior Advisory Services Consultant - Remote

UnitedHealth Group•Eden Prairie, MN

3d•Remote

About The Position

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. 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 data sets and be familiar with how to quickly identify issues with claims data quality. Candidates 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 health care data. Must be familiar with claim structure, data components and relationships that contribute to reimbursement
4+ years of 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 frameworks and / or reimbursement methodologies including DRG, APC, RBRVS, Per Diem, etc.

Nice To Haves

Experience with SAS
Intermediate to Advanced Proficiency level of skill in Excel
Proven solid communication skills and attention to detail. Must have the ability to communicate effectively with all audiences (technical to senior leadership)
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

Responsibilities

Support analytics service delivery within the Medicaid domain by providing deep analytic and implementation support of payment methodologies based on claims and policy-based definitions across Commercial, Medicare, Medicaid, and Life Science domains
Specific projects may include developing client reimbursement benchmarks, hospital margin analytics, CMS new technology application support, and development and ongoing maintenance of episodic value-based payment models and other analytic projects
Translate documented requirements into solutions using the appropriate tools/processes (e.g., business use cases, process flows, application configuration workbooks)
Assist in the maintenance and support of the Normalized Pricing and Prometheus products, including product releases and updates and collaboration with different teams to synchronize the algorithm across various platforms
Complete data intake and processing of large CMS datasets for use in both standardized and ad-hoc client projects as well as tracking of developments from CMS related to claims pricing systems (DRG, APC, HCPCS)
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 and Prometheus products, including supporting product implementation and consultation, making recommendations, performing pricing, analyzing, and explaining results, identifying issues, and providing solutions
Organize and communicate results to customers in the form of spreadsheet reports and other analytic outputs including data visualization
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