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Senior Business Analyst, Risk Adjustment - Remote job in Philadelphia at UnitedHealth Group

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Senior Business Analyst, Risk Adjustment - Remote at UnitedHealth Group

Senior Business Analyst, Risk Adjustment - Remote

UnitedHealth Group Philadelphia, PA (Remote) Full-Time

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. Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by diversity and inclusion, career growth opportunities and your life's best work.(sm)

As part of the Optum Insight Payer Analytics Team, we support all risk adjustment efforts for our Medicaid Managed Plan clients. We are analytics partners who provide expertise to finance, operations, accounting, and clinical leads to identify coding gaps, assess opportunity, forecast, and analyze risk. If you eat, breathe, and sleep risk adjustment like we do, then this is the right place for you! If you’re not a risk adjustment expert, but hungry, driven, and willing to learn, we will help you become one of the best-in-class experts in the field.

As a Senior Business Analyst, you will support key efforts around risk score forecasting, revenue assessment, predictive suspecting, program evaluations, and strategic guidance related to Medicaid Risk Adjustment. 

The role also requires knowledge of the Medicaid payment models, and expert knowledge of data access, construction, and manipulation of large datasets to support planned analyses, using advanced SQL development or PySpark.

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

  • Assist in leading complex analytic projects leveraging data from multiple sources

  • Understand and apply highly technical specifications to healthcare datasets

  • Serve as key healthcare economics and analytics contact for local, regional, and national Medicaid plans and key finance and operations stakeholders

  • Multitask, prioritize, adapt to change, work well under pressure in an entrepreneurial environment, meet deadlines, and manage a project from start to finish

  • Develop full understanding of state guidelines and specifications as it relates to Medicaid Managed Plan and Risk Adjustment

  • Identify and implement appropriate analytic and forecasting methodologies 

  • Develop and manage advanced forecast models

  • Design, produce and support development of dashboards and key performance indicator reports to meet customer requirements

  • Leverage and coordinate enterprise-wide capabilities to meet business-specific needs

  • Educate non-technical stakeholders on risk adjustment topics from the clinical, operational, and financial perspective

  • Communicate results to relevant audiences, and seek and apply feedback into future iterations and new analytic development  

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.

Required Qualifications:

  • Degree in Economics, Statistics, Finance, Health Administration, Mathematics or related field or 4+ years of equivalent professional working experience  

  • 3+ years of advanced analytics (data analysis, statistical analysis, data manipulation, data extraction, and reporting) experience with 1+ year focused on healthcare data

  • Advanced proficiency with SQL development or PySpark with the ability to code and write your own queries

  • Proficient with MS Excel, including creating Macros, Pivot Tables, SUMIFS, SUMPRODUCT, and VLOOKUPs, etc.

Preferred Qualifications:

  • Medicaid experience 

  • Experience in supporting finance and accounting partners through an analytics focused role, including forecasting techniques

  • Experience in predictive modeling, data manipulation, reporting, and analysis

  • Experience synthesizing analysis into actionable and easy to digest insights

  • Experience measuring impact and ROI of operational programs and services

  • Knowledge of the Risk Adjustment models and applicability as it relates to revenue cycle analytics and forecasting

  • Knowledge of State regulations and specifications regarding Medicaid risk adjustment

  • Advanced to expert proficiency with SAS and/or other data manipulation and statistical tools

Careers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.

California, Colorado, Connecticut, Nevada, New York City, or Washington Residents Only: The salary range for California/Colorado/Connecticut/Nevada/New York City/Washington residents is $67,800 to $133,100. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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