Analyze Medicaid enrollment, provider and claims data and document requirements, use cases.
Identify and document data anomalies and collaborate with cross functional teams for effective resolution
Share use cases to data analysts for profiling, review results and infer compliance to Medicaid / CMS processes and guidelines.
Able to juggle multiple priorities and ensure availability to questions and clarifications from data analysts.
Be a self-starter and able to thrive in a environment with little guidance.
Bachelor's degree in related field or equivalent experience
10 years of Healthcare data analysis experience supporting business initiatives through data analysis, writing business requirements and user acceptance testing of various systems
4 years experience in working with State Medicaid and CHIP agencies
Experience working with PERM, TMSIS, CMS Federal Reporting or similar projects
Experience in HEDIS , CHIPRA or similar quality metrics
In-depth knowledge of CMS reporting requirements for Medicaid
In-depth understanding of FFS, Managed Care claim adjudication processes from enrollment to funding/finance.
3 years of managed care encounters experience
Knowledge of health insurance, HMO and managed care principles including Medicaid and Medicare regulation.
Knowledge of Affordable care act and eligibility
Able to perform Complex Data analysis using SQL, Excel against data warehouses utilizing large datasets
Versatile in working with relational databases preferably Oracle
Knowledge of Quality of Care program is highly preferred
Strong time management and organizational skills
Excellent interpersonal, oral and written communication skills
Effective organizational, analytical, time management, problem-solving, and multi-tasking skills and habits; ability to complete assignments under tight deadlines with little/no direct supervision
Knowledge of data integration, software enhancements/planning and Agile methodologies
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: Medicaid, customer facing, business, Springfield, IL, Illinois
Unitedhealth Group Inc.