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Healthcare Economic Consultant - Multiple Locations & Telecommute more...
Location:Franklin, TN
First posted:May 10, 2017

The Healthcare Economic Consultant position requires a strong analytical skill set, data analysis and healthcare claims expertise (HCFA/UB) and will involve learning about solutions to detect incorrectly paid claims for all UHC segments (Medicare, Medicaid and Commercial) and claim platforms. The role is responsible for utilizing all data mining tools (i.e. SAS, Self Service, SQL, Excel, etc.) to complete complex healthcare data queries to identify aberrancies, trends, outliers within claim data. This role will focus on developing medical concepts in partnership with our Analytic and Operation partners to identify and research potential claims hypotheses; size concepts for potential opportunity and savings; and when confirmed, present the findings for solution approval. This position requires excellent communication skills in partnership with our client. An understanding of healthcare payment methodologies and policies as well as coding is recommended.

Primary Responsibilities:

Researching and developing potential claim overpayment hypotheses

Responsible for utilizing data mining tools (i.e. SQL, Access, Excel) in order to analyze data to support of their hypothesis

When opportunity is confirmed, the analyst will present the findings for solution approval in a clear and concise manner utilizing data reports and summaries to support their concept

An understanding of healthcare payment methodologies and policies as well as coding is necessary

Required Qualifications:

3+ years of experience in healthcare (billing, coding, auditing claims)

3+ years of data analysis experience

3+ years of experience with claims processing or adjudication systems (Such as UNET, COSMOS, Facets, Diamond, etc. or provider billing / coding knowledge on Professional and Facility claims)

Maintains working knowledge of Medicare rules and regulations and knowledge of procedure and diagnosis codes (CPT, ICD10 coding, HCPCS, APC and DRGs)

Strong computer skills: MS Excel, Word, PowerPoint

Knowledge of Medicare, Medicaid and / or Commercial health plan and payment methodology
Preferred Qualifications:

Bachelors degree or equivalent experience

Advanced degree in health care or medical field

Coding Certification through AAPC or AHIMA

Knowledge of UHC systems as well as desk top applications

Ability to identify payment errors regardless of the claim system by reviewing data and possessing claims coding experience

Ability to breakdown a complex problem into individual root causes

Data System expertise in SAS, SQL

Knowledge of statistical methods used in the evaluation of healthcare claims data

Auditing or trending for outliers experience

Strong project management approach with excellent critical thinking and problem solving skills

Exceptional communication and negotiation skills

Self-starter with the ability to support multiple concurrent projects and meet delivery timelines
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)

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: Healthcare Economic Consultant,claims processing,UNET, COSMOS, Medicare, Medicaid,Franklin, TN, Tennessee, Eden Prairie, MN, Minnesota, Frederick, MD, Maryland, telecommute, telecommute, remote, work from home

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