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.
The Provider Not Participating (PNP) Senior Business Analyst will complete telephonic outreach directly to provider offices to obtain their cooperation with Retrospective Chart Review Retrievals. The PNP Business Analyst will research provider contact information as well as any provider specific requests regarding membership research, chart reductions, payment or other requests to negotiate medical chart retrievals with provider offices.
Clinical Performance (CP) is charged with effectively implementing, monitoring, and executing on government pay for performance programs with a special focus on Risk Adjustment. CP processes on a national level by providing support in all markets served by Optum Care Delivery.
Positions in this function conduct and manage outcomes of various studies that include analyzing, reviewing and presenting information for operational and business planning. They support short and long term operational/strategic business activities. They also develop and implement effective/strategic business solutions through research and analysis of data and business processes.
This position will report into the Clinical Performance Retrospective Team and will be responsible for a variety of functions related to the general management and general business operations across the company and its businesses.
Business/Department Description
The chart review program is a cornerstone of the enterprise clinical performance team that contributes to the overall financial value provided by operations. Provides client service and analytics to the CDOs with relation to their retrievals, and reviews as well as helping to support new initiatives for the program.
The retrospective chart review program is a risk adjustment program intended to identify and capture undocumented diagnosis data supported within the medical records. All diagnosis data must be supported by the member’s medical record documentation. Federal regulations require us to review and validate medical records to avoid underpayments and overpayments.
Mission
Our mission is to improve health outcomes for Medicare patients by capturing accurate coding for risk adjustment. Help people live healthier lives and help make the health system work better for everyone.
You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
Act as an escalation point for Medicare Advantage medical chart retrievals
Perform provider contact information research
Perform membership analysis to meet provider office requirements
Obtain provider office commitment to provide medical records or allow our retrieval vendor to obtain the medical records
Collaborate with Care Delivery markets and business stakeholders to overturn provider objections
Demonstrate flexibility and adapt to change
Possess good independent decision-making capabilities
Assesses and interprets customer needs and requirements
Identifies solutions to non-standard requests and problems
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:
High School Diploma / GED (or higher)
2+ years of experience working in a Windows environment, including MS Word, MS Excel, and Outlook
2+ years of experience using data analysis to obtain missing information and answer provider questions
Preferred Qualifications
2+ years of Medicare Advantage experience
2+ years of call center or outreach experience
2+ years of claims or informatics experience
Experience working with medical records
Demonstrate excellent verbal and written communication skills
Excellent customer service orientation
Proven team player and team building skills
Ability/flexibility to assume responsibilities and tasks in a constantly changing work environment
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
For more information on our Internal Job Posting Policy, .
The salary range for this role is $71,600 to $140,600 annually based on full-time employment. 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.
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.
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.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.
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UnitedHealth Group
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