IT Business Consultant - US Telecommute

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 IT Business Consultant will work with a team on reporting affordability savings and researching issues to determine feasibility of reducing medical costs through prospective solutions of claim system processes and claim business rules. Positions in this function are responsible for investigating, recovering and reporting all types of claim affordability savings from multiple programs within payment integrity for health plans, commercial customers and government entities. Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance. Primary Responsibilities:• Examine, assess, and document business operations and procedures to ensure data integrity, data security and process optimization• Investigate, recover, and reporting all types of claim affordability savings as well as recovery and resolution for health plans, commercial customers, and government entities • Investigate and report recoveries and payables on program claims and file management • Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance • Use pertinent data and facts to identify and solve a range of problems within area of expertise • Generally work is self-directed and not prescribed• Works with less structured, more complex issues• Serves as a resource to others• Help to coordinate and/or perform database updates and reporting functions• Facilitate annual budget targets reporting• Ability to move from task to task and prioritize work load• Other duties as assignedThis role will help us achieve the following:• Ability to drill down the root cause for both the positive and negative variances of results• Ability
to mitigate deficiencies for negative variances and replicate
initiatives driving positive variance across platforms/ plans• Ability to accurately report/ forecast savings at a product level, which will assist in identify bidding on additional products.• Ability to more adequately support State requests for payment integrity information• Ability to validate savings submitted through contractors

Required Qualifications:• High School Diploma or GED• Experience working with the medical claims platform FACETS• 1+ year of experience analyzing data and identify cost saving opportunities• Ability to utilize formulas, pivot tables, and macros  within Microsoft Excel• Ability to develop databases and queries to summarize data in Microsoft Access• Ability to utilize data to develop graphs and charts to import in Microsoft PowerPoint• Ability to develop PowerPoint presentations• 2+ years of SQL query experience Preferred Qualifications:•       Undergraduate degree (or higher) • Knowledge of Medicaid/ Medicare reimbursement methodologies• 2+ years of experience with claims auditing and researching claims information• Knowledge of claims processing systems and guidelines/ processes• Healthcare experience• Healthcare data analysis skills• Ability to work with Microsoft Visual Studio• 1+ year of SQL Server Database Management experience• 1+ year of Oracle experiencePhysical 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 computerCareers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 17 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work. 

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.