14 days old

Application Managed Services ( AMS ) Business Analyst - 929950

Salt Lake City, UT 84111
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  • Job Code
    929950

UnitedHealth Group is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think about HealthCare. Here, innovation isn't about another gadget, it's about transforming the health care industry. Are you ready to make a difference? Start doing your life's best work(sm).

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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 clients 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.

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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 strong 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 savings targets.
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Youll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

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Primary Responsibilities:

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  • Support Optum medical Claims Editing System (CES) for AMS clients
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  • Partner with Client Leader to establish and strategize how to achieve savings targets
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  • Identify, research, develop, and size via SQL, new prepayment editing opportunities for use in Claims Editing System (CES) edit application for assigned healthcare payers
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  • 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
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  • Present new edit concepts to clients during Governance meetings, effectively explaining the rules intent, support, anticipated exposure, and influencing the client to adopt the rule
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  • Execute the Rule Approval process
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  • Generate innovative editing ideas that can be scaled across the organization
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  • Stay current on client configuration and new CES functionality in order to recommend the most effective rule design
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  • Conduct root cause analysis, including investigation into Knowledge Base updates, LCD updates, and rule logic defects, to recognize and remediate escalated issues
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  • Interpret complex reimbursement language, policies and methodologies
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  • Define, create and maintain rule requirements
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  • Define acceptance criteria / build rule scenarios/ test cases
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  • Analyze, Validate and Implement incoming data configuration updates
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  • Perform configuration changes in client environments
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  • Conduct Unit Testing and validate that all functions perform according to the relevant specifications
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  • Acquire and maintain working knowledge of multiple platform specific knowledge, customer customizations, databases, file systems and architecture that support the CES application
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  • Review quarterly Knowledge Base release to determine custom rule impact and maintenance needs
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  • Contributor to AMS Community: Ask an Expert, provides feedback for updated content - works with lead/owner of the committee
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  • Building out non-proprietary and proprietary rule library: proactively share information with internal client teams
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  • Execute small to large projects from inception through implementation
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  • Define and document projects including scope and objectives
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  • Present and evaluate solutions objectively and facilitate conflict resolution
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  • Evaluate system changes for downstream system and/or organizational impacts
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  • Prioritize and track all defects/issues to resolution, escalate as appropriate
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  • Work with the business to set expectations around capacity planning
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  • Build and maintain working relationships with stakeholders
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  • Facilitate and/or assist with group meetings via Teams and telephonically, providing agendas and meeting minutes
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  • Identify new opportunities to improve processes, customer relationships, while increasing our value to our client
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  • Provide required Issue/Risk, Status and Time reporting
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  • Serve as a mentor to new Business Analysts, and routinely identify, develop, and share best practice experience with peers
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Youll 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.

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Required Qualifications:

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  • 5+ years previous Healthcare Industry experience (Healthcare reimbursement, claims adjudication, procedure/diagnosis coding knowledge)
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  • 3+ years of experience with Medicare/Medicaid policy guidelines
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  • 3+ years of experience performing Analysis and interpretation of business needs around client payment policies and translate into Business Requirements
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  • 3+ years of experience interfacing and presenting with Clients
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  • Strong analytical and troubleshooting skills
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  • Excellent interpersonal, written and verbal communication skills
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  • Comfortable interfacing at the Executive level
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  • Proficient with MS Office Applications
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  • Demonstrated competency in large-scale organizations within a matrix environment
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  • If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders
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Preferred Qualifications:

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

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Colorado Residents Only: The salary range for Colorado residents is $79,700 to $142,600. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.

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*All Telecommuters will be required to adhere to UnitedHealth Groups Telecommuter Policy

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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.

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

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Job Keywords: application manager, AMS, business analyst, analyst, business, technology, healthcare, Salt Lake City, UT, Utah, Telecommute, Remote, Work from home

Posted: 2021-06-02 Expires: 2021-07-02

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

Sponsored by:
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Application Managed Services ( AMS ) Business Analyst - 929950

UnitedHealth Group
Salt Lake City, UT 84111

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