Unitedhealth Group Inc.
Eden Prairie , MN 55344
Tough challenges? We know a thing or two about those. When you're on a mission to help people live healthier lives, the stakes couldn't be higher. As a HEDIS Medical Record Review (MRR) Data SME Consultant, you will help rewrite the future of the health care system. You'll serve as the Subject Matter Expert (SME), analyze data and deliver bold, business-savvy ideas to impact the lives of millions. Along with ground-breaking challenge, you'll have the support and resources of a Fortune 6 company. Join us! Your passion for performance can fuel your life's best work.(sm)
You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Understand HEDIS Medical Record Review (MRR) data requirements from point of abstraction, data result coding, MRR data integration, scoring of measure results against administrative data and NCQA guidelines on medical record data use for reporting, and final data results on IDSS.xml files and PLD
Read, and write SQL code with knowledge of inner and outer joins, table and view properties, and ability to review and understand a data dictionary as it relates to a database environment
Understand Supplemental data concepts for HEDIS and how it impacts MRR process and rules for converting MRR data into future administrative data source for data runs
Provide guidance to clients on MRR data issues and MRR data questions and set up data tollgates / controls
Provide strategic support in preparation of the HEDIS Roadmap, HOQ, HEDIS audit, and Primary Source Verification
Perform additional duties as required / assigned
Are you up for navigating a complex matrix of business units and teams? We share a near obsessive desire to outperform and outdo our own achievements across our entire global business landscape. It's going to take all you've got to create valuable solutions to improve the health care system.
Bachelor's degree or 5 equivalent years of experience
3 years of experience in Medical Record Review (MRR) projects at a vendor level and/or health plan organization level
3 years of current HEDIS experience, performing a wide range of functions with strong focus on data analysis and reporting
3 years of writing SQL code
Knowledge of CMS Star Rating programs impacted by MRR data
1 years of experience working in a matrix environment
3 years of working with final submission files to NCQA, CMS, California P4P, NY QARR, and/or other state submissions
Knowledge of Medicaid and/or Medicare programs
Familiarity with ICD-9-CM / ICD-10-CM, CPT, DRG, LOINC, HCPCS, TOB, POS, NDC coding
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: HEDIS, STARS, MRR, Medical Record Review, SQL, MEDICARE STARS, data analysis, telecommute, telecommuter, telecommuting, remote, travel, work from home