United Health Group is looking for motivated individuals to conduct comprehensive analyses and audits of Individual Health Record (IHR) of patients, and their clinical and claims data ingested from different sources. The ingested member data can be from UHG internal database sources as well as external client data sources including clinic and hospital systems. The objective of this role is to validate that the member data are appropriately displayed in the IHR application and 100% clinical accuracy is ascertained before patients and providers have access to these IHRs.
- Analyze and understand the data sources for the respective datasets - Rx Claims, Lab, Medical Claims, CDA, EMR, etc.
- Analyze and understand the characteristics of the data and information, as it is displayed in the IHR UI
- Analyze and document data profiling for each population and define the parameters for various profiling methods
- Understand different healthcare quality guidelines such as HEDIS, P4P, PQRS, MACRA, ICSI and different measures / measure groups
- Understand aspects of quality measures, such as denominators, numerators, exceptions and exclusions
- Analyze and document test scenarios and test cases to validate the representation of data
- Work with SME / experts / clinical professionals and quality testing teams to assure accuracy of the data being brought from various sources
- Work independently and with other QA team members
- Develop creative ideas for improving the testing process
- Assist with training and mentoring of other clinical QA
- Stay up-to-date on new interface features, improvements and versions
- Provide quick turn-around on analysis of issues identified
- Compare and contrast data between system builds/code updates
- Exercise the highest degree of professionalism and confidentiality when analyzing protected health information
- Ability to understand complex requirements and derive solutions, work with others in different time zones and on different continents, work independently and within a team setting and learn quickly and desire to take on new challenges
- All other duties and responsibilities as assigned
- Bachelor’s degree in Information Systems, Laboratory Medicine, Healthcare Information Technology, Nursing, or other healthcare profession
- In lieu of degree, equivalent combination of education and experience in Healthcare IT equal to five (5) years
- Skilled user of Microsoft Excel (analysis of data) and Microsoft Word
- Experience with project and/or product management lifecycles
- Experience with analyzing and data modeling of medical claims, membership data, lab results or pharmacy data
- Experience in handling clinical terminologies used in patient clinical records, including lab and radiology, Pharmacy, immunization, surgeries, treatment plans, case notes, allergies, etc.
- Understanding of clinical taxonomies (ICD10, CPT, LOINC, NDC, SNOMED, etc.)
- Knowledge of current healthcare data transmission types (X12, HL7, CCDA) and various file types (txt, xml, csv)
- Familiarity with EMR integration to import and export clinical data from other EMRs or health system data sources
Careers at UnitedHealth Group. We have modest goals: Improve the lives of others. Change the landscape of health care forever. Leave the world a better place than we found it. Such aspirations tend to attract a certain type of person. Crazy talented. Compassionate. Driven. To these select few, we offer the global reach, resources and can-do culture of a Fortune 5 company. We provide an environment where you're empowered to be your best. We encourage you to take risks. And we offer a world of rewards and benefits for performance. We believe the most important is the opportunity to do your life's best work.(sm)
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: Senior Clinical Quality Analyst, Minnetonka, MN, Minnesota