Senior Consultant, PPS - Application Managed Services - Remote

UnitedHealth Group • Plymouth, MN

21h • 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.
We are looking for an experienced Senior Consultant as an addition to the Optum Reimbursement Advisory Services team. Responsibilities require strong understanding healthcare claims data, basic PPS concepts, UB04 and HCFA 1500 claim content, ability to conduct research of varying federal and states Medicaid regulations to determine hospital, ambulatory surgery, and physician provider reimbursement rules. Candidates must also demonstrate excellent data management and data quality 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

• 5+ years of experience working in a healthcare data or regulatory environment
• 3+ years of experience with Health plan or payment integrity space; facility contract configuration, claims operations or IT
• 2+ years of experience with EasyGroup, PSI or Rate Manager
• 2+ years of experience pricing Medicare, Medicaid, or Commercial hospital facility claims (inpatient and outpatient)
• 2+ years of experience configuring and customizing software solutions
• 1+ years of experience breaking down information and developing solutions
• 1+ years of experience documenting client operational and technical workflow
• Basic knowledge and understanding of Prospective Payment Systems – may include DRG, APC, OCE, ESRD, CAH, ASC, SNF, HHA, LTC, IPF, IRF, FQHC, Hospice, Professional claims
• Solid understanding healthcare claims data, basic PPS concepts, UB04 and HCFA 1500 claim content, EDI, 837i/837p
• Proficiency with Microsoft Word, Excel, PowerPoint, Visio
• Proven ability to conduct research on varying federal and states Medicaid regulations to determine hospital, ambulatory surgery, and physician provider reimbursement rules
• Demonstrate excellent data management and data quality skills
• Travel 25%25 of the time

Nice To Haves

• Experience with Tableau
• Claims system knowledge – Trizetto Facets, NetworX Pricer, QNXT, Health Rules Payer, IKA Claims, Burgess Systems, Epic Tapestry, 3M
• SQL proficiency - write queries, load tables, build output file
• Proven exposure to Optum CES
• All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Responsibilities

• Payment Integrity Data Analytic Support: Apply analytical / quantitative approach to problem solving
• Knows how to obtain and use data, and comfortable with statistical concepts
• Utilize communication skills to influence and negotiate
• Utilize one’s strong interpersonal skills to work with all levels of management across all functional areas, as well as business partners through internal entities
• Provider Reimbursement support: Researching, compiling, interpreting, documenting, developing appropriate specifications for, testing and deploying custom pricing solutions
• Work directly with Optum colleagues and customers to determine and document reimbursement or product training and education needs
• Delivering customer training and education programs
• Conducting regulatory research to determine revisions/updates to various federal and state Medicaid payment systems and updating the appropriate library of education materials to reflects current rule and regulations
• Works directly with customers to define other project requirements, provide assistance to answer questions related to project outcomes
• Assist as needed with other claims pricing projects

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed