Senior Healthcare Economic Consultant - Remote

UnitedHealth Group•Plymouth, MN

9d•$91,700 - $163,700•Remote

About The Position

Optum Insight is improving the flow of health data and information to create a more connected healthcare system. As an Analytic Development Sr. Consultant, you will support the identification, development, and presentation of new medical cost savings opportunities for clients. You will assess opportunities using data insights, tools, policies, industry trends, and input from experts across Optum. Working with internal and external business constituents, you will identify growth opportunities within payment integrity businesses and support savings delivery through deployment. This role works remotely from anywhere in the U.S. However, hires in the Minneapolis or Washington, D.C. area must work in an office at least four days per week. Remote employees must follow UnitedHealth Group’s Telecommuter Policy. The salary range is $91,700–$163,700 annually, based on full-time employment. Compensation depends on factors including local labor markets, education, work experience, and certifications.

Requirements

BA/BS degree or equivalent experience.
At least 3 years of healthcare experience in billing, coding, or claims auditing.
At least 2 years of experience analyzing large data sets.
At least 1 year of experience with both OPRS and CAP systems.
At least 1 year of SQL experience, including PLSQL, Teradata, or MySQL.
At least 1 year of experience with claims processing or adjudication systems such as UNET, COSMOS, Facets, or Diamond, or provider billing/coding knowledge for professional and facility claims.
Understanding of healthcare payment methodologies, policies, and coding.
Working knowledge of coding standards, billing rules and regulations, and procedure and diagnosis codes, including CPT, ICD-10, HCPCS, APC, and DRGs.
Computer skills with Access, Excel, Visio, and PowerPoint.
Collaborative and consultative approach, with the ability to quickly establish credibility with management across multiple functional areas.
Solid project management approach and strong critical-thinking and problem-solving skills.
Exceptional presentation, communication, and negotiation skills.
Ability to think creatively and break complex problems into individual root causes.
Self-managed, self-starting approach and ability to support concurrent projects and meet tight delivery timelines.

Nice To Haves

Advanced degree in a healthcare or medical field.
Coding certification through AAPC or AHIMA.
At least 5 years of healthcare industry experience in Medicare, Medicaid, or Commercial, with deep exposure to Payment Integrity.
At least 3 years of experience analyzing large data sets.
At least 2 years of experience working in a matrixed, highly adaptive environment with tight deadlines.
Knowledge of statistical methods used to evaluate healthcare claims data.
Expert SQL coding skills and ability to run test queries to assess the viability of concepts under review.

Responsibilities

Identify savings initiatives that produce specific, measurable results and provide timely, meaningful client updates.
Work with multiple clients on pre- and post-pay analytics and create hold analytics.
Conduct analytical, experimental, investigative, and fact-finding work to support concept development.
Build relationships with internal and external stakeholders to define, align, and deliver payment integrity initiatives for assigned clients.
Influence senior leadership to adopt new ideas, approaches, and products.
Recommend changes to product development procedures based on market research and emerging trends.
Use data-mining tools, including SQL, Access, and Excel, to analyze data and support hypotheses.
Research policies, coding guidelines, and regulations supporting hypotheses.
Develop clear, concise, and comprehensive business requirements documentation.
Communicate concepts to business partners and clients and respond to questions about hypothesis-testing logic, documentation, and analytics.
Perform quality audits of claim overpayment results and monitor analytic performance.
Provide mentorship and guidance to Analytic Development Consultants.
Serve as an industry thought leader and practice subject-matter expert.
Integrate enterprise AI and advanced digital tools into business workflows, set performance and technology-adoption goals in team development plans, and remove barriers to adoption.
Work within both OPRS and CAP systems.