Senior Recovery/Resolutions Analyst - Clinical – Eden Prairie, MN

Position Description:

Welcome to one of
the toughest and most fulfilling ways to help people, including yourself. We
offer the latest tools, most intensive training program in the industry and
nearly limitless opportunities for advancement. Join us and start doing your
life's best work.

The Sr. Business Analyst - Clinical will have
clinical responsibility within the Operations Staging Team (OST) for testing
new analytics, supporting and managing new rule implementations, and providing feedback
to proposals of all detection methods at various tollgates. This position will
also have project management/coordination responsibility within OST.

Primary Responsibilities:

This individual would
be responsible for testing new analytics and performing medical records
reviews for rule validationThis role is
responsible for supporting and managing new rule implementations and
identifying and resolving issues and removing barriersThis individual
would also be responsible for creating data management reports and
dashboards which will be an input to overall rule performanceThis role will
also provide clinical feedback to proposals of all detection methods at
various tollgatesThis role provides
clinical consultative feedback and partnership with AAL during the rule
development process This role is also
responsible for determining operational readiness from a business and clinical
operations perspectiveExamine, assess,
and document business operations and procedures to ensure data integrity,
data security and process optimizationProject management
supportIdentification of
process efficiency and effectiveness improvements Provide
explanations and interpretations within area of expertiseMay perform
additional duties as assigned

Requirements:

 

High school
diploma or GED1+ years as a
certified coder OR RN, LPN with 1+ years of current experience with an
unrestricted license1+ years
CPT/HCPCS/ICD-9 coding experienceExperience with
DRG coding and other facility coding Experience using
claims platforms such as UNET, Pulse, NICE, Facets, Diamond, etcBasic level of
Microsoft Excel
Assets:Experience in managing diverse group of stakeholdersLean/Six Sigma exposure1+ year of project management experience

Soft Skills:Self-starter with the ability to work independentlyAdapt to changing environment  Must have excellent verbal and written communication skillsPhysical Requirements and Work Environment:Frequent speaking, listening using a headset, sitting, use of hands/fingers across keyboard or mouse, handling other objects, long periods working at a computerService center environment with moderate noise level due to Representatives talking, computers, printers, and floor activity
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

Diversity creates a healthier atmosphere: 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.