Data Analyst - Telecommute

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life’s best work.(sm)

The Data Analyst is responsible in assisting the lead Sr. Business Analyst of Claims Edit System (CES) development by providing expertise and general claims support by reviewing, researching, and investigating claim adjudication along with CMS Payment methodologies and reimbursement guidelines (i.e. - Correct Coding Initiatives (CCI), Local Coverage Determinations (LCD), and National Coverage Determinations (NCD)) related to CES adjudication.

The Data Analyst of the CES application development is responsible for designing, building and configuring applications to meet business process and application requirements. Direction from lead Sr. Business Analyst would include the development in the design, coding, testing, debugging, and review process of CES determinations for the overall operational business needs. Supporting analyst would also assist in coordinating development while ensuring effective communication between team members and other IT functional areas.

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

Primary Responsibilities:

• Assist lead Sr. Business Analyst with successful installation, implementation, and configuration of custom rules and application system rules
• Apply analytical / quantitative approach to problem solving reimbursement solutions
• Knows how to obtain and utilize data, and comfortable with statistical concepts
• Utilize communication skills in assisting to inform and educate end users
• Requires solid interpersonal skills across all functional areas
• Work within SharePoint ticketing system to track escalated issues and answer issues submitted by other teams
• Assisting with communicating any responses back to end users, other teams and management
• Assisting with implementation changes as needed and outlined in various requests
• Work directly with lead Sr. Business Analyst and end users to determine and document CES methodology, education needs and requirements for training teams
• Work directly with lead Sr. Business Analyst to define other project requirements, provide assistance to answer questions related to project results
• Assist as needed with all other duties as assigned
• Engage and dedicate end users either via email, Microsoft teams, or SharePoint ticketing to help apply updates and\or Troubleshooting issues using Regulatory documentation
• Support Business Partners with questions around integration
• Support and compile documentation: Processes and Procedures (including but not limited to specific tracking, network configuration, rules of engagement)

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:

• High School Diploma / GED (or higher)
• 4+ years of experience / knowledge in the healthcare industry and / OR clinical experience
• 4+ years of experience with software support
• Technical background / experience
• SQL knowledge
• Proficiency with Microsoft Word (ability to create, edit, save, and send documents), Microsoft Excel (ability to create, edit, save, and send spreadsheets)
• Familiar with CMS Payment methodologies and reimbursement guidelines (i.e. – Correct Coding Initiatives (CCI), Local Coverage Determinations (LCD), National Coverage Determinations (NCD)

Preferred Qualifications:

• Bachelor’s Degree (or higher) in healthcare OR business related field
• Experience in working with the CES (Claims Edit System) software
• Experience in working with any of the following adjudication platforms: QNXT, Facets, Epic Tapestry, Amisys, HealthRules
• Relational Database experience to include understanding of database scripting and troubleshooting in Oracle and / OR SQL Server

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 WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 550,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)

WellMed was founded in 1990 with a vision of being a physician-led company that could change the face of healthcare delivery for seniors. Through the WellMed Care Model, we specialize in helping our patients stay healthy by providing the care they need from doctors who care about them. We partner with multiple Medicare Advantage health plans in Texas and Florida and look forward to continuing growth.

Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $54,400 to $97,000. The salary range for Connecticut / Nevada residents is $60,000 to $106,700. 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 Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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