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Form of workOptum 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)
Positions in this function research and investigate key business problems through quantitative analyses of utilization and healthcare costs data. Provides management with statistical findings and conclusions. Identifies potential areas for medical cost improvements and alternative pricing strategies. Provides data in support of actuarial, financial and utilization analyses.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
- Identify, create, and develop a portfolio of cost savings initiatives that drive specific and measurable results for assigned clients while providing timely and meaningful client updates
- Perform and participate in iterative analytical, experimental, investigative and other fact-finding work in support of concept development
- Establish solidmatrixed relationships with internal stakeholders to define, align, and deliver payment integrity initiatives in support of assigned clients
- Influence senior leadership to adopt new ideas, approaches, and/or products
- Recommend changes to current product development procedures based on market research and new trends
- Industry thought leader and subject matter expert for Medical claims, related trends, pricing, and cost management initiatives
- Lead concepts/projects from conceptualization to completion
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:
- 5+ years of experience auditing, billing, and/or coding claims
- 5+ years of experience in the health care industry (Medicare, Medicaid, Commercial) with deep exposure to Payment Integrity
- 3+ years of work experience in highly collaborative and consultative roles, with ability to establish credibility quickly with all levels of management across multiple functional areas
- 3+ years of experience with interpreting data sets
- 3+ years of experience presenting proposals to stakeholders and internal customers
- 3+ years of Project Management experience
- Maintains working knowledge of CMS rules and regulations and billing codes and related services
Preferred Qualifications:
- Undergraduate Degree
- Advanced degree in health care or medical field
- Coding certification through AAPC or AHIMA
- 3+ years of experience in claims adjudication or revenue cycle management
- 2+ years of experience working in a matrixed and highly adaptive environment handling tight deadlines
- Proficiency with SQL, SAS and/or other statistical programs
- Solid computer skills: Excel, Visio, PowerPoint, Tableau
- Solid project management approach with excellent critical thinking and problem-solving skills
- Self-managed, self-starter with the ability to support multiple concurrent projects and meet tight delivery timelines
- Exceptional presentation, communication and negotiation skills
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, or Washington residents is $101,200 to $184,000. 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.
