UnitedHealth Group is among the most ambitious Fortune 25 companies you'll ever meet. Through our family of businesses, we're working to make the health care system perform better for more people, in more ways than ever.
Simply put, we think the entire system can be greater than it's ever been. And that drives us to work harder, aim higher, and expect more from one another.
Here, you'll be empowered to make an immediate impact for millions of others. And you'll achieve more than you ever expected. How does that fit with your plans?
Healthcare Quality Analyst - Phoenix, AZ-314500
UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.
Description AmeriChoice is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.
If you're ready to help make health care work better for more people, you can make a historic impact on the future of health care at AmeriChoice.
We contract with states and other government agencies to provide care for over two million individuals. Working with physicians and other care providers, we ensure that our members obtain the care they need with a coordinated approach.
This enables us to break down barriers, which makes health care easier for our customers to manage. That takes a lot of time. It takes a lot of good ideas. Most of all - it takes an entire team of talent.
Health Care Quality Analyst - Phoenix, AZ
Primary Responsibilities:
- Develop and implement efficient and effective test plans for new systems problems and/or enhancements, including understanding of QA methodology, processes and associated automated testing tools
- Interact with key business partners, including: Project Managers, Health Plan Operations, Network Management, IT
- Assess/interpret intent of member benefit packages and provider contracts to determine configuration accuracy
- Ensure system configuration adheres to Medicare, Medicaid, and other market-specific regulations
- Design, execute, and analyze test cases to verify accuracy of physician, institutional, ancillary provider contract installation; member benefit package configuration; system claim edits, third party pricing and editing tools; claim payment trends
- Must demonstrate command of claim coding, payment concepts
You can be a part of this team. You can put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered. Qualifications Qualifications:
- 3 to 5 years experience working with healthcare claims, including processing
- Solid knowledge of coding and payment principles (certified coder not required)
- Analytical skills, including ability to perform root cause analysis
- 3 to 5 years working in Medicaid or Medicare claim environment
- 2+ yrs MS Office skills - Outlook, Word, Excel required
- 3 to 5 years experience interpreting institutional, ancillary, and professional contracts and fee schedules
- 3 to 5 years experience with health care benefit principles, payment principles and medical terminology
- MS Access experience preferred, but not required
- Reporting tools, such as PL SQL preferred
- Experience working with business projects preferred
- Diamond and FACETS experience is strongly desired
- Audit and testing experience a plus
- Bachelor's Degree is preferred
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. |
