Senior Healthcare Economic Consultant - Remote

Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us in making healthcare work better for everyone through people-led, responsible AI while Caring. Connecting. Growing together.

As an Analytic Development Sr. Consultant, you will be responsible for supporting the identification, development, and presentation of new medical cost savings opportunities on behalf of our clients. This position will support the assessment of new opportunities based on data insights leveraging tools, policies, industry trends, and by soliciting input from a broad network of experts across Optum. This highly trained industry expert will work with internal and external business constituents to determine opportunities for growth within our core payment integrity businesses and be responsible for savings delivery through deployment.

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.

Primary Responsibilities:

Identify savings initiatives that drive specific and measurable results, providing timely and meaningful client updates

Will need to work with multiple clients, experience with pre and post pay analytics, work on creating Hold analytics for multiple clients

Participate in analytical, experimental, investigative and other fact-finding work in support of concept development

Establish solid relationships with internal and external 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

Utilize data mining tools (i.e. SQL, Access, Excel) in order to analyze data to support of their hypothesis

Research policies, coding guidelines, and regulations that would support the hypothesis being developed

Develop Business Requirement Documentation in a clear, concise, and comprehensive manner

Clearly communicate concept to business partners/clients and be able to appropriately respond to questions relating to the logic utilized within hypothesis testing, documentation, and the analytic

Perform quality audits for claim overpayment results and monitoring analytic performance

Provide mentorship and guidance to Analytic Development Consultants

Industry thought leader and practice SME

Integrate enterprise AI and advanced digital tools into business workflows, setting performance and technology-adoption goals in team development plans, and actively removing barriers to accelerate adoption.

Will need to work within both OPRS and CAP systems

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:

BA/BS degree or equivalent experience

3+ years of experience in healthcare (billing, coding, auditing claims)

2+ years of experience conducting analysis on large data sets

1+ years of experience with both OPRS and CAP systems

1+ years of SQL experience (PLSQL, Teradata, MySQL)

1+ years of experience with claims processing or adjudication systems (Such as UNET, COSMOS, Facets, Diamond, etc. or provider billing / coding knowledge on Professional and Facility claims)

An understanding of healthcare payment methodologies, policies, and coding are necessary

Maintains working knowledge of coding standards, billing rules and regulations and knowledge of procedure and diagnosis codes (CPT, ICD10 coding, HCPCS, APC and DRGs)

Solid computer skills: Access, Excel, Visio, PowerPoint

Highly collaborative and consultative style with ability to establish credibility quickly with all levels of management across multiple functional areas

Demonstrated solid project management approach with excellent critical thinking and problem-solving skills

Demonstrated exceptional presentation, communication and negotiation skills

Demonstrated ability to think outside of the box and breakdown complex problems into individual root causes

Proven to be self-managed, self-starter with the ability to support multiple concurrent projects and meet tight delivery timelines

Preferred Qualifications:

Advanced degree in health care or medical field

Coding certification through AAPC or AHIMA

5+ years of experience in the health care industry (Medicare, Medicaid, Commercial) with deep exposure to Payment Integrity

3+ years of experience conducting analysis on large data sets

2+ years of experience working in a matrix and highly adaptive environment handling tight deadlines

Knowledge of statistical methods used in the evaluation of healthcare claims data

Expert SQL coding skills and ability to run test queries to ensure viability of concepts under review

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 - $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and help make the health system work better for everyone. Together, we are shaping the future of healthcare by harnessing technology and innovation to make care simpler to navigate, more affordable and more connected for the people we serve. We are committed to creating an inclusive workplace where everyone feels welcomed, valued, heard and respected, empowering people to bring their authentic selves to work and strengthening our collective impact through diverse talents, backgrounds, experiences and perspectives.

UnitedHealth Group and its affiliated brands are an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group and its affiliated brands are a drug-free workplace. Candidates are required to pass a drug test before beginning employment.