Senior Consultant, Payment Integrity

UnitedHealth Group - Eden Prairie, MN3.6

Full-time | Custom_1Estimated: $82,000 - $110,000 a year
No industry is moving faster than health care. And no organization is better positioned to lead health care forward. We need attention to every detail with an eye for the points no one has considered. The rewards for performance are significant. You'll help improve the health of millions. And you'll do your life's best work.(sm)

We are looking for an experienced Senior Consultant as an addition to the Optum Payment Integrity Practice in Optum Payer Consulting. Responsibilities require strong understanding healthcare claims data, basic PPS concepts, UB04 and HCFA 1500 claim content, ability to conduct research of varying federal and states Medicaid regulations to determine hospital, ambulatory surgery, and physician provider reimbursement rules. Candidates must also demonstrate excellent data management and data quality skills.

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

Primary Responsibilities:
Payment Integrity Data Analytic Support:- Apply analytical / quantitative approach to problem solving
Knows how to obtain and use data, and comfortable with statistical concepts
Able to use data analytic expertise to assist in the development of enhanced payment integrity fraud, waste and abuse analytic tools, reporting capability and value
Utilize communication skills to influence and negotiate
Utilize one’s strong interpersonal skills to work with all levels of management across all functional areas, as well as, business partners through internal entities
Provider Reimbursement support:- Researching, compiling, interpreting, documenting, developing appropriate specifications for, testing and deploying Optum Reimbursement Solutions supported PPS Rate Files
Work directly with Optum colleagues and customers to determine and document Client PPS payment system methodology education needs.
Work directly with Optum colleagues and clients to determine and document Client requirements for Optum PPS product training
Conducting customer PPS payment system education programs
Conducting customer PPS product training
Conducting regulatory research to determine revisions/updates to various federal and states Medicaid PPS payment systems and updating the appropriate Optum PPS Payment System library of education materials to reflects current regulations
Works directly with customers to define other project requirements, provide assistance to answer questions related to project result
Assist as needed with other Reimbursement Solutions projects

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:
Bachelor’s Degree or 2+ years of experience with EasyGroup, WebStrat or RateManager
5+ years or experience working in a healthcare data or regulatory environment
Basic knowledge and understanding of Prospective Payment Systems - includes DRG, APC, OCE, ESRD, CAH, CMG, RUG, RBRV
Experience with EasyGroup, WebStrat or RateManager
Experience pricing Medicare hospital facility claims (inpatient and outpatient)
Experience breaking down information and developing solutions
Healthplan experience in facility contract configuration, claims or IT
Experience documenting client operational and technical workflow
Experience configuring and customizing software solutions
SQL experience - write queries, load tables, build output file
Facility claims reimbursement experience – Medicare, Medicaid, Commercial
Strong understanding healthcare claims data, basic PPS concepts, UB04 and HCFA 1500 claim content
Ability to conduct research on varying federal and states Medicaid regulations to determine hospital, ambulatory surgery, and physician provider reimbursement rules
Demonstrate excellent data management and data quality skills
Experience with Microsoft Word, Excel, PowerPoint, Visio
Travel 30% of the time

Preferred Qualifications:
Experience with Optum CES
.NET or IIS experience
Claims system knowledge – Trizetto Facets, NetworX Pricer, QNXT, Health Rules Payer, IKA Claims, Burgess Systems, Epic Tapestry, 3M
Experience with Tableau

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.
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.