Application Managed Services - AMS - Business Analyst - Remote

Davita Inc.; Eden Prairie (MN); Remote; USD 71,000 - 141,000; Full time

Job summary

A leading healthcare organization seeks a Business Analyst for its Application Managed Services team. The successful candidate will support clients in optimizing their claims editing systems, requiring strong analytical skills and effective communication abilities. This remote position provides the opportunity to influence healthcare outcomes significantly while enjoying professional growth within a collaborative environment.

Benefits

Comprehensive benefits package

Incentive and recognition programs

401k contribution

Qualifications

• 3+ years of experience in the Healthcare Industry.
• Experience with Medicare/Medicaid policy guidelines.
• Proven ability to translate complex technical requirements.

Responsibilities

• Support the Optum medical Claims Editing System (CES).
• Identify and develop new prepayment editing opportunities.
• Generate innovative editing ideas that can be scaled across the organization.

Skills

Analytical skills

Communication

Problem-solving

Education

Bachelor's degree

Tools

MS Office

Job description

Application Managed Services - AMS - Business Analyst - 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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

We have a position open for a Business Analyst to support the Optum Application Managed Services (AMS) Team. The AMS team engages in long term commitments and partnerships.

AMS provides full-service operation to our clients with a proactive approach to business communication, growth and problem resolution. The AMS team partners with health plan clients to become an extension of their organization. The highly seasoned staff is dedicated to managing Claims Edit System (CES) as well as looking at where CES fits in the client's "Ecosystem". AMS provides services that will help provide long term benefit for the client, not only direct savings, and increased revenue but also savings in process, manual effort, and other operational areas.

This role can be based in Salt Lake City or is available to telecommuters. The Business Analyst role requires a highly flexible and adaptable analyst with the ability to handle periods of stress and/or heavy workloads. Solid experience as a Business Analyst or similar role is required, along with demonstrated experience with healthcare claims, or Medical /Drug/ reimbursement policies. The BA must have the ability to not only facilitate meetings but also negotiate and drive effective solutions by proactively review profiling system rules, using coding, policy, reimbursement, clinical, and claims background to determine which rules can be presented to the payer for new medical cost savings opportunities as well as generate innovate editing ideas that can be scaled across organizations. This position requires solid communication skills with ability to liaison between technical and non-technical personnel. The ability to adeptly navigate ever changing priorities is also a key skill of the BA.

Additionally, the role requires the BA to become a Subject Matter Expert and provide end user training on the functionalized policies. The BA primarily works independently, however is also expected to work collaboratively across teams and the organization to support our client's needs and meet their affordability and saving's targets.

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

Primary Responsibilities:

• Support Optum medical Claims Editing System (CES) for AMS clients
• Partner with Client Leader to establish and strategize how to achieve savings targets
• Identify, research, develop, and size, new prepayment editing opportunities for use in Claims Editing System (CES) edit application for assigned healthcare payers
• Proactively review profiling system rules, using coding, policy, reimbursement, clinical, and claims background to determine which rules can be presented to the payer for new medical cost savings opportunities
• Present new edit concepts to clients during Governance meetings, effectively explaining the rule's intent, support, anticipated exposure, and influencing the client to adopt the rule
• Execute the 'Rule Approval' process
• Generate innovative editing ideas that can be scaled across the organization
• Stay current on client configuration and new CES functionality in order to recommend the most effective rule design
• Conduct root cause analysis, including investigation into Knowledge Base updates, LCD updates, and rule logic defects, to recognize and remediate escalated issues
• Interpret complex reimbursement language, policies, and methodologies
• Define, create and maintain rule requirements
• Acquire and maintain working knowledge of multiple platform specific knowledge, customer customizations, databases, file systems and architecture that support the CES application
• Review quarterly Knowledge Base release to determine custom rule impact and maintenance needs
• Building out non-proprietary and proprietary rule library: proactively share information with internal client teams
• Present and evaluate solutions objectively and facilitate conflict resolution
• Evaluate system changes for downstream system and/or organizational impacts
• Build and maintain working relationships with stakeholders
• Facilitate and/or assist with group meetings via Teams and telephonically, providing agendas and meeting minutes
• Identify new opportunities to improve processes, customer relationships, while increasing our value to our client
• Serve as a mentor to new Business Analysts, and routinely identify, develop, and share best practice experience with peers

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:

• 3+ years of Healthcare Industry experience (Healthcare reimbursement, claims adjudication, procedure/diagnosis coding knowledge)
• 3+ years of Medicare/Medicaid policy guideline experience
• 3+ years of experience performing Analysis and interpretation of business needs around client payment policies and translate into Business Requirements
• 3+ years of proven ability to interpret technical requirements and business requirements while coordinating with technical staff to help drive solutions for our customers
• 3+ years of proven ability to translate highly complex detailed clinical/technical solution concepts and articulate to technical and non-technical audiences
• 3+ years of experience interfacing with Clients
• 1+ years of experience interfacing at the Executive level
• Proficient with MS Office Applications

Preferred Qualifications:

• Experience with CES, Claims Manager
• Business Analyst software support experience
• Training experience
• Medical Coding experience or certified medical coder (AHIMA or CPC)

Soft Skills:

• Solid analytical and troubleshooting skills
• Excellent interpersonal, written, and verbal communication skills
• Ability to manage multiple priorities and execute deliverables on time
• Demonstrated outstanding time management skills
• Ability to shift priorities quickly, handling multiple tasks and competing priorities
• Highly motivated and innovative, with the ability to work as part of a high-performance team as well as independently
• Demonstrated competency in large-scale organizations within a matrix environment

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

The salary range for this role is $71,600 to $140,600 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.

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

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