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Analytic Development Consultant, Commercial R&D -Remote at UnitedHealth Group

Analytic Development Consultant, Commercial R&D -Remote

UnitedHealth Group Dallas, TX (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 an Analytic Development 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 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 position requires a strong analytical skillset, data analysis and healthcare claims experience (HCFA/UB) to detect incorrectly paid claims for multiple segments (Medicare, Medicaid, Commercial) and claim platforms.

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

Primary Responsibilities:

  • Researching and developing potential claim overpayment hypotheses

  • Utilizing data mining tools (i.e. SQL, Access, Excel) in order to analyze data to support of their hypothesis

  • Researching policies, coding guidelines, and regulations that would support the hypothesis being developed

  • Developing 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

  • Performing quality checks for claim overpayment results and monitoring analytic performance

  • Present research findings in a clear and concise manner utilizing data reports and summaries to support concepts

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:

  • 2+ years of experience in healthcare (billing, coding, auditing claims)

  • 1+ years of experience with conducting analysis on large data sets

  • 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)

  • Understanding of healthcare payment methodologies, policies, and coding are necessary

  • Working knowledge of coding standards, billing rules and regulations and knowledge of procedure and diagnosis codes (CPT, ICD10 coding, HCPCS, APC and DRGs)

  • Excellent computer skills: Excel, Word, PowerPoint

Preferred Qualifications:

  • Advanced degree in health care or medical field

  • Coding Certification through AAPC or AHIMA

  • 1+ years of SQL experience (PLSQL, Teradata, MySQL)

  • Technical Writing and/or Business Requirement Documentation experience 

  • Knowledge of statistical methods used in the evaluation of healthcare claims data

  • Proficient with SQL coding and ability to run test queries to ensure viability of concepts under review

  • Excellent critical thinking and problem-solving skills

  • Excellent communication and negotiation skills

  • Flexible and ability to handle multiple priorities at the same time

  • 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

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 Residents Only: The salary range for California, Colorado, Connecticut, Nevada, New York City, or 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.

Recommended Skills

  • Analytical
  • Auditing
  • Big Data
  • Billing
  • Claim Processing
  • Communication
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