Employer: UnitedHealth Group

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration, and opportunity and this is what you get. Leading edge technology in an industry that’s improving the lives of millions. Here, innovation isn’t about another gadget, it’s about making health care data available wherever and whenever people need it, safely and reliably. There’s no room for error. Join us and start doing your life’s best work.

The position will work closely with proprietary pricing algorithms and claims analytics, including Normalized Pricing. Qualified candidates will possess coding/developer experience and have a strong understanding of commercial, Medicaid, and Medicare Data files and the intake of those files. In addition, qualified candidates should understand reimbursement methodologies and concepts that include APC, DRG, Per Diem, RBRVS, etc. Candidates should also have experience working with large medical claims datasets, be familiar with how to quickly identify issues with claims data quality and possesses exceptional analytical skills.

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

Primary Responsibilities:

  • Act as a subject matter expert and support all code/algorithm development and maintenance associated with pricing solutions, develops a deep knowledge of consulting products and analysis methodologies
  • Analyze customer claims data to ensure that content provided by customers will support scope of work and to identify underlying issues within submitted content
  • Act as subject matter expert in all things related to our Normalized Pricing Algorithm
  • Devise analytic methodologies to deliver creative and meaningful results for our customers
  • Organize and communicate results to customers in the form of data sets, reports and/or presentations
  • Engage in the maintenance of existing and development of new products and solutions to enhance revenue growth opportunities
  • Work directly with customers throughout the lifecycle of a project

Required Qualifications:

  • Bachelor’s degree in Health Sciences, Computer Science, Analytics, or Business Administration
  • 7+ years of experience working with reimbursement methodologies (e.g., APC, DRG, Per Diem, etc.)
  • 7+ years working with and analyzing health care data, mainly UB (facility) and HCFA (professional) claim form content/familiar with claim structure, data components and relationships that contribute to reimbursement
  • 5+ years working in a coding and development environment with the ability to write and modify SQL code

Preferred Qualifications:

  • Excellent data quality assessment and analysis skills and a demonstrated ability to assess patterns, trends, and behaviors within large health care claims populations/ability to leverage knowledge of claims to quickly identify problems within a submitted claims dataset
  • Excellent data presentation skills/ability to develop formatted reports using MS Office tools that are presentable to customers (mainly Excel, PowerPoint, and Word)
  • Solid communication skills and attention to detail/ability to communicate effectively to all audiences (technical to senior leadership)