Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)
This role is critical in designing, testing, the rules logic algorithm and data life cycle of the gap and intake to support Business Requirements. The work done by this role has a direct effect on the number of Patient assessment forms generated for a client and impacts performance, productivity, and revenue metrics.
The analytics helps among other things help capture and code suspect dx and screenings by data mining the member’s data profile. Better recapture and coding directly has a revenue impact by reflecting the correct (risk adjustment factor) score, and applying the algorithms properly has a performance and productivity impact for all of our clients.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
- Work with provider(s) and Business partners in formulating, enhancing rule logic/algorithms
- Work with clinical coding teams to assign and update code sets based on regulatory or otherwise scheduled updates
- Work on requirements for gap management life cycle, how and when it starts and how and when it ends, and the related statuses and other criteria
- Understand and work on all the various workflows (eg. Risk - AO, Risk – IRQ, Risk – PAF, Screenings, RAF, Rendering/preferred provider, Annual Visit etc.)
- Work and help with PI planning and Agile work methodology
- Help conduct review meetings with business stakeholders and translate those into features in Aha for the technical teams
- Represent OPSI with other teams both within and without RQNS
- Serve as a SME for the technical teams, and have the ability to give them the big picture in relation to the feature that individual teams are working on
- Participate in client onboarding projects and give guidance from clients, and interface with business
- Lead the team during ad-hoc analysis requests/questions from clients, and interface with business
- Summarize and present dashboards with platform activity to senior management/executives
- Manage multiple priorities
- Have experience and expertise in SQL
- Be able to read and write technical business requirements documentation with knowledge of content to effectively communicate requirements to technical teams and stakeholders
- Ability to understand instructions and requirements and deliver quality work
- Self-motivated and ability to troubleshoot and follow up with resources to clarify and correct documentation and workflows
- Experience working in a matrix environment
- Good understanding of an SDLC process and ability to provide recommendations on best practices for development, testing, and deployment
- Conduct business, functional, technical, and data analysis to define product requirements for all aspects of healthcare applications including data schema definition, data verification, data quality, data load, analytics rule interpretation and implementation, UAT and testing
- Be able to work with ambiguity
- Be able to manage and prioritize large projects with great visibility
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.
- Bachelor's Degree or equivalent years of experience
- 2+ years of data analysis experience
- 2+ years of experience working with certification to NCQA, CMS, and/or other state measure requirements
- 2+ years of experience writing SQL and/or PL/SQL
- 1+ years of CMS risk adjustment model/version experience or ACA or Medicaid model risk adjustment. HEDIS, STARS, State quality performance measurement experience performing a wide range of functions with solid focus on measures development
- 1+ years of experience working in a matrix environment
- Intermediate knowledge of Excel
- Knowledge of Medicare, Medicaid and/or ACA programs
- Knowledgeable of current trends in HEDIS and CMS Quality Rating System in managed health care
- Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation.
- Knowledgeable of current trends in HEDIS in managed health care
- Knowledge of NCQA, CMS, HOS, and CAHPS requirements
- Familiarity with ICD-9-CM, CPT, DRG, LOINC, HCPCS, TOB, POS, NDC coding
To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.
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.
Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $66,100 to $118,300. The salary range for Connecticut/Nevada residents is $72,800 to $129,900. 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.
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.