Senior Healthcare Economic Consultant – Remote

UnitedHealth Group•Eden Prairie, MN

1d•$91,700 - $163,700•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. As an Analytic Development Sr. Consultant, you will be responsible for supporting the identification, development, and presentation of new medical cost savings opportunities on behalf of our clients. This position will support the assessment of new opportunities based on data insights leveraging tools, policies, industry trends, and by soliciting input from a broad network of experts across Optum. This highly trained industry expert will work with internal and external business constituents to determine opportunities for growth within our core payment integrity businesses and be responsible for savings delivery through deployment. 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.

Requirements

BA/BS degree or equivalent experience
3+ years of experience in healthcare (billing, coding, auditing claims)
2+ years of experience conducting analysis on large data sets
1+ years of SQL experience (PLSQL, Teradata, MySQL)
1+ years of experience with claims processing or adjudication systems (Such as UNET, COSMOS, Facets, Diamond, etc. or provider billing / coding knowledge on Professional and Facility claims)
Maintains working knowledge of coding standards, billing rules and regulations and knowledge of procedure and diagnosis codes (CPT, ICD10 coding, HCPCS, APC and DRGs)
An understanding of healthcare payment methodologies, policies, and coding are necessary
Solid computer skills: Access, Excel, Visio, PowerPoint
Highly collaborative and consultative style with ability to establish credibility quickly with all levels of management across multiple functional areas
Demonstrated solid project management approach with excellent critical thinking and problem-solving skills
Demonstrated exceptional presentation, communication and negotiation skills
Demonstrated ability to think outside of the box and breakdown complex problems into individual root causes
Self-managed, self-starter with the ability to support multiple concurrent projects and meet tight delivery timelines

Nice To Haves

Advanced degree in health care or medical field
Coding certification through AAPC or AHIMA
5+ years of experience in the health care industry (Medicare, Medicaid, Commercial) with deep exposure to Payment Integrity
3+ years of experience conducting analysis on large data sets
2+ years of experience working in a matrix and highly adaptive environment handling tight deadlines
Knowledge of statistical methods used in the evaluation of healthcare claims data
Expert SQL coding skills and ability to run test queries to ensure viability of concepts under review

Responsibilities

Identify savings initiatives that drive specific and measurable results, providing timely and meaningful client updates
Participate in analytical, experimental, investigative and other fact-finding work in support of concept development
Establish solid relationships with internal and external stakeholders to define, align, and deliver payment integrity initiatives in support of assigned clients
Influence senior leadership to adopt new ideas, approaches, and/or products
Recommend changes to current product development procedures based on market research and new trends
Utilize data mining tools (i.e. SQL, Access, Excel) in order to analyze data to support of their hypothesis
Research policies, coding guidelines, and regulations that would support the hypothesis being developed
Develop Business Requirement Documentation in a clear, concise, and comprehensive manner
Clearly communicate concept to business partners/clients and be able to appropriately respond to questions relating to the logic utilized within hypothesis testing, documentation, and the analytic
Perform quality audits for claim overpayment results and monitoring analytic performance
Provide mentorship and guidance to Analytic Development Consultants
Industry thought leader and practice SME