Senior Consultant, PPS - Application Managed Services - Remote

Optum 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. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

We are looking for an experienced Senior Consultant as an addition to the Optum Reimbursement Advisory Services team. Responsibilities require solid 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 work remotely * 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
• Utilize communication skills to influence and negotiate
• Utilize one's solid 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 custom pricing solutions
• Work directly with Optum colleagues and customers to determine and document reimbursement or product training and education needs
• Delivering customer training and education programs
• Conducting regulatory research to determine revisions/updates to various federal and state Medicaid payment systems and updating the appropriate library of education materials to reflects current rule and regulations
• Works directly with customers to define other project requirements, provide assistance to answer questions related to project outcomes
• Assist as needed with other claims pricing 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:

• 5+ years or experience working in a healthcare data or regulatory environment
• 3+ years of experience with Health plan or payment integrity space; facility contract configuration, claims operations or IT
• 2+ years of experience with EasyGroup, PSI or Rate Manager
• 2+ years of experience pricing Medicare, Medicaid, or Commercial hospital facility claims (inpatient and outpatient)
• 2+ years of experience configuring and customizing software solutions
• 1+ years of experience breaking down information and developing solutions
• 1+ years of experience documenting client operational and technical workflow
• Proven basic knowledge and understanding of Prospective Payment Systems - may include DRG, APC, OCE, ESRD, CAH, ASC, SNF, HHA, LTC, IPF, IRF, FQHC, Hospice, Professional claims
• Proven solid understanding healthcare claims data, basic PPS concepts, UB04 and HCFA 1500 claim content, EDI, 837i/837p
• Ability to conduct research on varying federal and states Medicaid regulations to determine hospital, ambulatory surgery, and physician provider reimbursement rules
• Demonstrated excellent data management and data quality skills
• Demonstrated proficiency with Microsoft Word, Excel, PowerPoint, Visio
• Ability to travel 25% of the time

Preferred Qualifications:

• Exposure to Optum CES
• Demonstrated SQL proficiency - write queries, load tables, build output file
• Proven claims system knowledge - Trizetto Facets, NetworX Pricer, QNXT, Health Rules Payer, IKA Claims, Burgess Systems, Epic Tapestry, 3M
• Experience with Tableau

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

The salary range for this role is $89,800 to $176,700 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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. 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 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.