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. Individuals with the tenacity and the dedication to make things work better for millions of people all over our country.
Position Purpose:
Research and investigate key business problems through business and strategic analysis that are impacting Encounter submissions and Encounter reporting. This includes the documentation of business requirements, identification of solution alternatives and determining best practice solutions that can be leveraged across our multiple markets. Coordinate a cross functional team that is geographically distributed to analyze business processes around claims adjudication to determine the best solutions for enhanced encounter submissions. Server as a leader within the Encounter function to bring multiple business partners together and identify potential areas for process improvements and drive the team to successful implementations.
Position Responsibilities:
• Review state contracts and document their impact on claims adjudication and encounter processes.
• Analyze Encounter business process results and functional requirements and appropriately document and communicate captured information for prioritization and improvement.
• Leverage technical data skills to identify and provide examples of claims or encounters not processing correctly for review by the cross functional team.
• Provide encounter business process understanding to team solutions to ensure best practice implementations.
• Lead, without direct supervisory responsibilities, prioritization of issues and team generation of solutions for specified items within required timelines.
• Lead working sessions with cross functional team to ensure the team understands the details of the issues and the solutions are documented for proper sign-off and implementation.
• Create and document business requirements within the claim systems for efficient encounter submissions.
• Identify opportunities for process redesign and improvement.
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
Knowledge/Experience:
- Bachelor's degree or equivalent in Health Care Administration, Information Technology or related field.
- Five or more years of IS/IT with Managed Care Claims or Encounters and/or business analyst preferably in managed care or Medicaid preferred.
- Knowledge of claims adjudication engines like Diamond, Facets and Cosmos with data manipulation skills with SQL Scripting, Excel, Access preferred.
- Presentation skills with tools like PowerPoint and Word are essential to perform this role.
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.
