Senior Provider Data Analyst - Remote

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us and start doing your life's best work.(sm)

This is a mission-critical position that's all about leveraging your knowledge, experience, and analytical skills to improve data accuracy for our network partners and providers.  In this role, you will not only ensure provider data is maintained consistently and manage critical/complex data escalations to resolution, but also through this work, positively impact provider experiences and member outcomes.  We're achieving higher levels of service in how provider data is managed and performs in our systems - join us and you'll play a key role in helping healthcare professionals focus on taking care of patients instead of insurance administration. This role will put you on a team of incredibly talented business professionals with the resources, backing, and opportunities you need to succeed.

You'll enjoy the flexibility to work remotely* from anywhere within the U.S. as you take on some tough challenges. Needs to live in US

Primary Responsibilities:

• Internally and externally facing - owns the author and execution of new agreement requests, implementation and maintenance of provider contract terms and data which impacts claim payment or directory depiction 
• Performs critical thinking analysis of each case submission including the reason for original request such as rework, terms in error, cred import errors utilizing SOPs, decision tree, knowledge central, market exception grid, etc., and makes required updates to database(s)
• Direct loading of urgent demographic and contractual cases to ensure expedited results for the providers in markets supported 
• Appropriately logs each actionable step of the process in IMPACT, continuously tracking submission request through final audit and successful completion of the ask, E2E
• Manages all clarifications for the entire region regardless of submission origination to ensure quality completion of the ask
• Conducts audits and provides feedback to reduce errors and improve processes and performance in collaboration with PDO
• Analysis of large data set Project requests for BAPA automation and submissions through PhyCon
• Streamlines communication between UHN and PDO regarding contract/demographic updates by consistently following processes to eliminate handoffs and rework
• Improves relationships with providers through researching, resolving provider data issues accurately and timely
• Handles the most complex and difficult provider groups in the region
• Addresses top priority (DOI/DOH/CMS/legislative/executive) issues
• Identifies recurring/systemic issues
• Creates efficiencies in PDO interactions
• Ensures high quality data submissions for groups/territories
• Researches issues surrounding the accurate and timely loading of contractual and demographic data
• Collaborates with the contractors, advocates, and PDO to examine larger-scale provider issues, determines root causes rework cases, and coordinates solutions
• Reduces contract/demographic errors that affect members of gated and capitated products: E&I, M&R, C&S, Exchanges, etc.
• Performs contract audit requests 
• Performs regular contract analysis for high-profile provider groups
• Supports QuEST Quality Audit Programs
• Works in conjunction with managers to develop best practices
• Mentors new and junior team members

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:

• Undergraduate degree and/or 3 years of equivalent experience
• Proficiency with all UHC provider data systems (NDB, CLM) and claims platforms (UNET, COSMOS, CSP Facets) used in the region
• Advanced proficiency with Excel, including use of filter, remove duplicates, text to columns, and basic formulas, etc.
• Advanced proficiency in NDB provider data loading for delegated and non-delegated providers
• Proven exceptional skills in manipulating data, attention to detail, solid organizational skills
• Proven excellent written and verbal communication skills, including ability to communicate at all levels including senior leadership and provider groups
• Proven solid analytical and problem-solving skills

 
Preferred Qualifications:

• Proficiency with multiple auditing tools, such as Examiner, Hive, NDAR, AMAARDI reporting
• Intermediate level of proficiency with CLM/CMD loading
• Intermediate level of proficiency with all physician contract reimbursement methodologies
• Solid knowledge of business processes that impact physician contact loading and auditing

Careers with UnitedHealthcare. Work with a Fortune 5 organization that's serving millions of people as we transform health care with bold ideas. Bring your energy for driving change for the better. Help us improve health access and outcomes for everyone, as we work to advance health equity, connecting people with the care they need to feel their best. As an industry leader, our commitment to improving lives is second to none.

California, Colorado, Connecticut, Nevada, New York, Rhode Island, or Washington Residents Only: The hourly range for California, Colorado, Connecticut, Nevada, New York, Rhode Island or Washington residents is $27.07 to $53.08. 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.