Use your Sharp Analytical Skills to help us support, compile and report key information! Create, enhance, and maintain budget or financial planning models, surveys, benchmarks. Evaluate, interpret and analyze data and business process and analyze / monitor new, routine and ad hoc reports. Provide support when compiling and reporting information and assume responsibility for data integrity among various internal groups and / or between internal and external sources. Support short term operational activities.
The Risk Adjustment Business Analyst performs data consolidation reports and analytical services in support of maintaining compliance with CMS standards. Analyst will interact with IT, vendors and internal coding team to maintain business analysis and operational needs. Develops and maintains various department reports. The analyst will gather, standardize and consolidate manual processes.
Positions in this function conduct and manage outcomes of various studies that include analyzing, reviewing, forecasting, trending, and presenting information for operational and business planning. They support short and long term operational / strategic business activities - by developing, enhancing and maintaining operational information and models. They also develop and implement effective / strategic business solutions through research and analysis of data and business processes. *Employees in jobs labeled with SCA must support a government Service Contract Act (SCA) agreement.
Strong analytical skills and data monitoring skills to identify issues
Ability to identify underlying causes and potential strategies for data submission issues
- Work with vendors to manage invoices and chart review data submissions
- Reconcile data on a regular basis on identified projects
- Proven ability to use and manage large datasets to perform analysis and report metrics
- 3+ years of healthcare claims experience
- 3+ years of data extracts and / or ETL processes
- 1+ years of experience working with SQL queries
- Proficient in MS Excel (pivot tables, v look ups)
- Proficient in MS Access (importing and exporting data, running queries)
- Lives within a commutable distance to Ontario, CA
- Experience with data analysis and prior data mining experience
- Experience with Medicare risk adjustment and STARS programs
- Experience with HEDIS
- Exposure to data modeling and experience with healthcare analysis / business intelligence tools: Tableau, etc
- Project team lead or project team SME experience
- Experience working with CMS monthly files (e.g., MMR, MOR, TRR, RAPS submissions)
- Knowledge of Medicare reimbursement policies
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system 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)
North American Medical Management, California, Inc (NAMM California) partnered with OptumHealth in 2012. NAMM California and OptumHealth share a common goal of bringing patients, physicians, hospitals and payers closer together in the mission to increase the quality, efficiency and affordability of care. NAMM California is a part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system. NAMM California develops and managers provider networks, offering a full range of services to assist physicians and other providers in supporting patient care coordination and their managed care business operations. For over 18 years, NAMM California has been an innovator in health care with a track record for quality, financial stability, extraordinary services and integrated medical management programs. NAMM California is well positioned to continually invest in its infrastructure and systems for the benefit of its provider clients and to accommodate the impending changes that will come forth from healthcare reform.
The NAMM California provider clients represent a network of almost 600 primary care physicians and over 3,000 specialists and work with the premier hospitals in their respective markets.
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: Risk adjustment, Medicare, analysis, analyst, business analyst, data, Ontario, CA, California