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  • Lexington, KY

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Sr Medicaid Data Analyst - Telecommute

UnitedHealth Group • Lexington, KY

Posted 7 days ago

Job Snapshot

Healthcare - Health Services
General Business, Health Care


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Job Description

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

Primary Responsibilities:

  • Using Client data, develop algorithms to identify overpayment related to fraud, waste, abuse and inappropriate utilization of service

  • Conduct provider investigations (both medical record reviews and on sites)

  • Assists on Projects as requested by Manager and BA Consultant (including vulnerability studies, analytical development, etc.)

  • Researches state and federal regulations and policy and procedures per clients

  • Researching, interpreting / identifying providers requiring potential investigations

  • Second reviewer of audit findings for appeals produced by internal auditors

  • Provides education on Algorithms for Clients and Optum staff - this includes documentation

  • Assist with Client and Corporate projects, presentations, etc.

  • Travel to Clients, Providers (varies)

  • All other duties as assigned

Required Qualifications:

  • Certified Coder in ICD 10

  • 3 years of Medicaid experience including an understanding of the Medicaid claim process

  • 3 years of Medicaid auditing and investigative experience

  • 3 years of developing data analysis

  • 1 year of experience in providing testimony on claim auditing and/or coding issues for appeals (both informal and formal hearings)

  • Experience in Excel, Access, Word at Intermediate Level

  • Self-directed

  • Good verbal and written communication skills


Preferred Qualifications:

  • Certified Coder in ICD 9

  • Medicare experience


Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)



*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy



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.

Job Keywords: ICD 10, ICD 9, certified coder, data analyst, Medicaid, claims, claim processing, MS Access, MS Excel, Excel, Access, Telecommute, Telecommuter, Telecommuting, Remote, Travel, Work from home

Job ID: 2551_769130
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