Manager Advisory SVCS - Payer Network Analytics - Telecommute

Careers at UnitedHealth Group

We're creating opportunities in every corner of the health care marketplace to improve lives while we're building careers. At UnitedHealth Group, we support you with the latest tools, advanced training and the combined strength of high caliber co-workers who share your passion, your energy and your commitment to quality. Join us and start doing your life's best work. SM


Compassion. It's the starting point for health care providers like you and it's what drives us every day as we put our exceptional skills together with a real feeling of caring for others. This is a place where your impact goes beyond providing care one patient at a time. Because here, every day, you're also providing leadership and contributing in ways that can affect millions for years to come. Ready for a new path? Learn more, and start doing your life's best work. SM

Our teams are helping people from around the world. We can bring out your best as you put your listening, analytical and problem solving skills to work in a setting that is geared to helping improve lives and enhance health care for millions. Here, you'll discover a wealth of pathways for professional growth within Customer Service, Billing, Claims, Enrollment & Eligibility and across our global economy. Join us and find out why this is the place to do your life's best work. SM

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.(sm)

This position requires expert level understanding of CMS Medicare FFS data and PPS payment methodologies. The position will have extensive interaction with external clients. The position will be responsible for working with clients to determine solutions using CMS data and then delivery and presentation of CMS data-centric analytics projects. Qualified candidates will possess a solid understanding of CMS data, reimbursement methodologies and concepts that primarily include APCs and MS-DRG. Knowledge of Per Diem and RBRV methodologies will be helpful. Candidates should have experience working with large medical claims datasets, be familiar with how to quickly identify issues with claims data quality and possess 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:
  • Develops deep knowledge of consulting product and analysis methodologies. Serves as subject matter expert on PPS reimbursement methodologies to internal and external clients
  • Analyzes CMS acquired data and customer claims data to ensure that content provided by customers will support scope of work and to identify underlying issues within submitted content
  • Acts as resource and provides insight into CMS proposed rules affecting hospital reimbursement
  • Devises analytic methodologies to deliver creative and meaningful results for our customers
  • Organizes and communicates results to customers in the form of data sets, reports and/or presentations
  • Engages in the maintenance of existing and development of new products and solutions to enhance revenue growth opportunities
  • Works directly with customers throughout the lifecycle of a project

You'll 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.

Required Qualifications:
  • Bachelor's degree, preferably in Mathematics, Health Sciences, Computer Science, Analytics, or Business
  • 5+ years in-depth experience working with PPS reimbursement methodologies (e.g. APC, MS-DRG)
  • 5+ 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
  • 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 a similar UnitedHealth Group-approved symptom screener. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained

Preferred Qualifications:
  • 3+ years working with CMS and CMS acquired data, and Optum's EasyGroup software suite
  • Experience working with and formal correspondence with CMS
  • Excellent data quality assessment skills
  • Ablility to leverage knowledge of claims to quickly identify problems within a submitted claims dataset
  • Excellent data analysis skills and a demonstrated ability to assess patterns, trends and behaviors within large health care claims populations
  • Excellent data presentation skills. Must be able to develop formatted reports using MS Office tools that are presentable to customers (mainly Excel, PowerPoint and Word)

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)

Colorado Residents Only: The salary range for Colorado residents is $94,500 to $171,700. 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.

*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: Manager Advisory SVCS, Payer Network Analytics, Telecommute, Telecommuter, Telecommuting, Work at Home, Work from Home, Remote