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Senior CECD Concept Researcher - Telecommute

UnitedHealth Group
Eden Prairie
79700.00 - 142600.00 USD Annual
Closing date
Oct 14, 2021

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Job Type
Full Time
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Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

We have a position open for a Clinical Consultant to support the Optum Application Managed Services (AMS) Team as a member of the Custom Edit Concept Development team (CECD). The AMS team engages in long term commitments and partnerships with large payer clients.

AMS provides full service operation to our clients with a proactive approach to business communication, growth and problem resolution. The AMS team partners with health plan clients to become an extension of their organization. The highly seasoned staff is dedicated to managing Claims Edit System (CES) as well as looking at where CES fits in the clients "Ecosystem". AMS provides services that will help provide long term benefit for the client, not only direct savings and increased revenue but also savings in process, manual effort and other operational areas. CECD supports the AMS team by finding custom editing opportunities for large payer clients based on findings from the client's claims experience to enhance customer value derived from CES.

This role is available to telecommuters. The Clinical Consultant role requires a highly flexible and adaptable consultant with the ability to handle periods of variable workloads. Significant experience as a consultant or similar role is required, along with demonstrated experience with healthcare claims, or Medical /Drug/ reimbursement policies. The Clinical Consultant must have the ability to not only facilitate meetings but also negotiate and drive effective solutions, while producing detailed business requirements and other required supporting materials. This position requires strong communication skills with ability to liaison between technical and non-technical personnel. The ability to adeptly navigate ever changing priorities is also a key skill of the Clinical Consultant. The Clinical Consultant must work independently, however is primary responsible for working collaboratively across teams and the organization to support our client's needs and meet their affordability and saving's targets.

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

Primary Responsibilities:

  • Identify savings initiatives at the code level that drive specific and measurable results for assigned clients, providing timely and meaningful client updates
  • Perform analysis, research, and other fact - finding work in support of concept development
  • Establish strong matrixed 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
  • Function as an industry thought leader and SME
  • Support Optum Claims Editing System (CES) for AMS clients
  • Identify new opportunities to improve processes, customer relationships, while increasing our value to our client
  • Develop strategic and innovative solutions related to cost containment
  • Provide clinical/coding support and guidance to the functional teams
  • Building out non-proprietary and proprietary rule library: proactively share information with internal client teams
  • Acquire and maintain working knowledge of multiple platform specific knowledge, customer customizations, databases, file systems and architecture that support the CES application
  • Execute small to large projects from inception through implementation
  • Present and evaluate solutions objectively and facilitate conflict resolution
  • Work with the business to set expectations around capacity planning

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:

  • Bachelor's degree or equivalent work exp
  • 4+ years Healthcare Industry experience (Healthcare reimbursement, claims adjudication, procedure/diagnosis coding knowledge, code editing experience across all code edit categories), Medicare/Medicaid policy guideline experience
  • SQL Experience
  • Experience interfacing with Clients
  • Translate payment/reimbursement policy into effective code edits
  • Perform Analysis and interpretation of business needs around client payment policies
  • Ability to translate highly complex detailed clinical/technical solution concepts and articulate to technical and non-technical audiences
  • Ability to manage multiple priorities and execute deliverables on time
  • Ability to shift priorities quickly, handling multiple tasks and competing priorities
  • Comfortable interfacing at the Executive level
  • Proficient with MS Office Applications-Excel, Word, PowerPoint
  • Demonstrated competency in large-scale organizations within a matrix environment
  • Proven success in payment integrity at other health plans or as a consultant to health plans

Preferred Qualifications:

  • Experience with commercial claim editors (CES, Cotiviti, Claims Xten, Zelis)
  • Nursing experience
  • Training experience
  • Database expertise
  • Analyst software support experience
  • Certified medical coder (AHIMA or CPC) or Medical Coding experience
  • Excellent interpersonal, written and verbal communication skills
  • Highly motivated and innovative, with the ability to work as part of a high performance team as well as independently

UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

Colorado Residents Only: The salary range for Colorado residents is $79,700 to $142,600. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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.

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy

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

Job Keywords: Senior CECD Concept Researcher, Healthcare, Healthcare Reimbursement, Claims Adjudication, Code Editing, Medicare, Medicaid, SQL, Claims Editors, CES, Cotiviti, Claims Xten, Zelis, Medical Coder, Nursing, Telecommute, Telecommuter, Telecommuting, Work from Home, Remote, WAH, Eden Prairie, MN, Minnesota

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