For you, quality counts. For UnitedHealthcare, part of the UnitedHealth Group family of businesses, delivering quality care starts with processes and documentation standards that are the best in our industry. As a Senior Clinical Quality Analyst, you'll be a force for positive change, guiding the development of comprehensive care plans that will help others live healthier lives. Join us and help guide our efforts to improve the patient experience.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Transform quality measures such as HEDIS, PQA, P4P, ACO and custom client measure specifications into text instructions in Excel so the developers can program requirements for the engine
Test case development for measures (i.e. test measure logic)
Documentation. BA team provides both internal and client documentation
Provides 2nd tier customer support
Coordination with developers, product management, and QA team
Certification for HEDIS and P4P (e.g. receipt of test decks from NCQA, coordination of testing, and revising measure logic as needed)
- Experience with aspects of national quality measures (through provider groups, payers, state/federal institutions), such as HEDIS, Medicare Stars, PQRS, Meaningful Use, State Medicaid programs. This experience could include quality improvement initiatives, reporting, EHR/Practice Management data analysis, writing business requirements or technical specifications, etc.
- Working knowledge of administrative claims data and medical coding systems (i.e. CPT, HCPCS, ICD-10, NDC)
- Experience with project and/or product management and lifecycles
- Solid PC computer skills with proficiency in MS Office applications
- Understanding of data inputs, outputs, relational database concepts
- Bachelor’s Degree
- ICD-10, CPT and HCPCS coding experience
- Understanding of clinical taxonomies (SNOMED, LOINC, RxNORM, etc)
- Knowledge of relational database structures
- Experience writing queries in analytics tools such as SQL or Microsoft Access
- Strong attention to detail and accuracy
- Excellent written/oral communication and listening skills
- Excellent evaluative, analytical and problem-solving skills
- Ability to understand complex requirements and derive solutions
If you're the kind of thinker and leader who wants to bring your contribution to a new level every day, here's your opportunity to do your life's best work.(sm)
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy
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.
Job Keywords: HEDIS, PQA, P4P, ACO, STARS, test release, Business Analyst, BA, telecommute, HCPCS, ICD-10, NDC, NCQA, CPT, Access, SQL, LONC, SNOMED, RxNorm, Telecommute, Telecommuting, Telecommuter, Work from home, WFH, Remote