Sr Business Analyst Medicaid Risk Submission – Remote

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

This position supports Optum Insight’s Medicaid risk submission business, focusing on client success, analysis and reporting, and building strong operational processes. A successful candidate will have experience working with 837 files and a strong working knowledge of Medicare/Medicaid encounter submissions. Candidates should possess intermediate to advanced SQL skills, with the ability to write complex queries, join multiple disparate datasets, and dive into data to provide clients with actionable insights. Responsibilities include identifying, building, and maintaining data reconciliation controls and reporting. This role will focus on hardening operations and building a scalable process to support expected growth. Join our fantastic, growing team and tackle some of healthcare’s greatest challenges.

Primary Responsibilities:

Provide direct support to the Medicaid Risk Submissions Manager and the suite of clients leveraging the submission product

Lead all ad hoc analyses requested by management to identify issues, data trends, and investigate discrepancies in data submissions

Provide insightful analysis to solve business problems encountered

Serve as SME for the inner workings of the Medicaid submission product

Mobilize thought processes or requests into actionable tasks

Support Medicaid Submission KPIs and ensure operational excellence

Serve as primary liaison in establishing, enacting, and performing all control reporting and reconciliation required of our submission product

Perform root cause analysis to identify any issues in current operational processing

Assist on special projects requested by leadership

Provide Subject Matter Expertise within Medicaid Submissions

Provide consultative approach to clients leveraging deep knowledge of Medicaid submissions, including awareness of changing industry landscape, trends, and regulations

Serve as 837 and EDI expert, assisting clients with EDI-related file submission issues

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

3 years of work experience in Healthcare encounter submissions, working with 837 files and EDI transactions.

3 years of work experience in gathering, analyzing, and reporting on data

Experience writing complex SQL queries (joining multiple data sets)

Experience with the Medicaid/Medicare encounter submission lifecycle

Experience working and presenting effectively with all levels of leadership, as well as business partners and staff.

Experience with planning projects from inception to closure and preparing status updates

Demonstrated ability to self-manage workstreams with limited input from a direct supervisor

Preferred Qualification:

Medicaid risk adjustment experience

All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, Washington, or Washington, D.C. Residents Only: The salary range for this role is $70,200 to $137,800 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

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.