Sr Consultant Analytic Development Commercial R&D - 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 inclusion, talented peers, comprehensive benefits and career development opportunities.

Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

As an Analytic Development Sr. Consultant, you will be responsible for supporting the identification, development, and presentation of new medical cost savings opportunities on behalf of our clients. This position will support the assessment of new opportunities based on data insights leveraging tools, policies, industry trends, and by soliciting input from a broad network of experts across Optum. This highly trained industry expert will work with internal and external business constituents to determine opportunities for growth within our core payment integrity businesses and be responsible for savings delivery through deployment.

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

For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.

Primary Responsibilities:

* Identify savings initiatives that drive specific and measurable results, providing timely and meaningful client updates

* Participate in analytical, experimental, investigative and other fact-finding work in support of concept development

* Establish solid relationships with internal and external stakeholders to define, align, and deliver payment integrity initiatives in support of assigned clients

* Influence senior leadership to adopt new ideas, approaches, and/or products

* Recommend changes to current product development procedures based on market research and new trends

* Utilize data mining tools (i.e. SQL, Access, Excel) in order to analyze data to support of their hypothesis

* Research policies, coding guidelines, and regulations that would support the hypothesis being developed

* Develop Business Requirement Documentation in a clear, concise, and comprehensive manner

* Clearly communicate concept to business partners/clients and be able to appropriately respond to questions relating to the logic utilized within hypothesis testing, documentation, and the analytic

* Perform quality audits for claim over payment results and monitoring analytic performance

* Provide mentorship and guidance to Analytic Development Consultants

* Industry thought leader and practice SME

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:

* BA/BS degree or equivalent experience

* 3+ years of experience in healthcare (billing, coding, auditing claims)

* 2+ years of experience conducting analysis on large data sets

* 1+ years of SQL experience (PLSQL, Teradata, MySQL)

* 1+ years of experience with claims processing or adjudication systems (Such as UNET, COSMOS, Facets, Diamond, etc. or provider billing / coding knowledge on Professional and Facility claims)

* Proven understanding of healthcare payment methodologies, policies, and coding are necessary

* Demonstrated working knowledge of coding standards, billing rules and regulations and knowledge of procedure and diagnosis codes (CPT, ICD
10 coding, HCPCS, APC and DRGs)

* Proven solid computer skills:
Access, Excel, Visio, Power Point

* Demonstrated highly collaborative and consultative style with ability to establish credibility quickly with all levels of management across multiple functional areas

* Proven solid project management approach with excellent critical thinking and problem-solving skills

* Demonstrated exceptional presentation, communication and negotiation skills

* Ability to think outside of the box and breakdown complex problems into individual root causes

* Ability to be self-managed, self-starter with the ability to support multiple concurrent projects and meet tight delivery timelines

Preferred Qualifications:

* Advanced degree in health care or medical field

* Coding certification through AAPC or AHIMA

* 5+ years of experience in the health care industry (Medicare, Medicaid, Commercial) with deep exposure to Payment Integrity

* 2+ years of experience working in a matrix and highly adaptive environment handling tight deadlines

* 3+ years of experience conducting analysis on large data sets

* Knowledge of statistical methods used in the evaluation of healthcare claims data

* Expert SQL coding skills and ability to run test queries to ensure viability of concepts under review

* All employees working remotely will…