Job Description

Healthcare Economic Consultant

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.

The Healthcare Economic Consultant is responsible for researching, sizing, and analyzing payment integrity content and innovation programs within the Concept Research and Development (CRD) space. This role involves collaboration with UHC business units, Business Analysts, UHC network teams, UHC policy departments, and other solutioning partners across Optum and UHC. The Consultant works alongside the CRD Ideator, supports the creation of documentation and slide decks, and navigates the PICOG Governance process with UHC. The Consultant collaborates with multiple teams on new concept initiatives, engages solutioning support when necessary, and addresses issues by coordinating with relevant teams within the UHG matrix. Additionally, Consultants develop status materials to communicate project progress, monitor concept analysis and approvals, and address any arising issues.

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:

• Build and maintain strong relationships with internal and external stakeholders to support the development and implementation of Payment Integrity Growth concepts
• Collaborate with Ideation SMEs and data analysts to develop business requirements for data criteria to support concept development
• Interpret and analyze data, sampling and testing to determine opportunity and removal of false positives
• Support Ideator in driving projects and concepts to completion by contributing to sizing lead, preparing power point slides, presenting to the client and working with operational partners to implement solutioning
• Ability to develop data stories from analyzed data resulting in viable solutions
• Participate and provide status updates to clients and business partners
• Participate in approval, governance and other presentations as needed
• Utilize analytic tools and strategies to produce analyses that enhance the yield and quality of solutions
• Identify opportunities for process reengineering, automation, quality improvement, and efficiency enhancements
• Collaborate with data science and delivery teams to meet operational, product development, and client requirements
• Monitor metrics and performance information for business review processes

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:

• 2+ years of experience auditing, billing, and/or coding claims within a Payment Integrity domain
• 2+ years of at least one core platform claims experience - Cosmos/CSP/UNET/NICE/Cirrus
• 2+ years of experience performing research and analysis of claims data and applying results to identify trends/patterns
• Experience with health care and analytics with ability to translate complex analytic results

Preferred Qualifications:

• Certification through AAPC or AHIMA
• Experience with Special Needs Plans (specifically DSNP, CSNP, ISNP, IESNP)
• Maintains working knowledge of CMS rules and regulations and billing codes and related services (CPT, HCPCS, ICD coding experience)
• Solid computer skills: Excel (Pivot Tables, Advanced Formulas, macros, etc..), Visio, PowerPoint, Tableau
• Demonstrated ability to be organized, disciplined and capable of ensuring a large volume of work is moving to schedule
• Demonstrated to be self-managed, self-starter, able to work in rapidly changing environment
• Demonstrated excellent verbal and written communication skills
• Demonstrated solid problem-solving skills, initiative, and creativity in anticipating and solving issues and implementing next steps

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). The salary for this role will range from $71,200 to $127,200 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.

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