Senior Claims Business Process Analyst - Tacoma, WA

Company:	UnitedHealth Group Company Profile \| Current Opportunities (4)
Job Location(s):	Tacoma
Employment Term:	Regular
Employment Type	Full Time
Start Date:	As soon as possible
Starting Salary Range:	Not Provided
Required Education:	Bachelor's Degree
Required Experience:	Open
Related Categories:	Miscellaneous

Position Description

Senior Claims Business Process Analyst - Tacoma, WA-331262

Description

Position Description:

Models and promotes the core values of the Department of Social and Health Services and OptumHealth Pierce Regional Support Network (RSN). The Data Specialist partners with the IT Manager, Data Manager, end users, and project management staff to implement and follow the business requirements for submitting encounter and native data from provider agencies and the RSN to Washington State Mental Health Department (MHD). The Data Specialist understands how information flows across different business processes and systems and uses that information to support encounter and native data reporting according to the State's definitions and rules. The ideal candidate would have had a technical and data background but has moved into a business analysis role. This individual will become familiar with the Netsmart applications and databases created to support Washington State Consortium providers and RSNs and apply that knowledge and data definitions to the testing and production of reports. Under the guidance of the IT Manager and Data Manager, this individual creates and runs daily, weekly, ad hoc and monthly data reports for both internal and external stakeholders. In the course of analyzing and managing data for reporting, this position will support data audits, performance monitoring, fraud and abuse checking, trending of service delivery activity, outcome measures, data reconciliation, and provider agency payments. As assigned by the managers, this position will assist with database and operational control procedures, including monitoring security, data integrity, error reports, error resolution, report schedules, provider and RSN issue and problem resolution.

Primary Responsibilities:

Is aware of and understands the business and data dependencies that are required between business operations and systems functions
Understands general project management principles, objectives, benefits, resource planning
Has experience with medical and behavioral health claims and encounter processing, HIPAA Transaction and Code Sets, financial reporting, and management of reporting schedules
Understands and identifies dependencies inside and outside the business and systems processing cycle
Follows data analysis methodologies to organize data and report requirements according to documented processes and procedures
Reviews requirements and change requests with the IT Reporting Manager and Data Manager
Demonstrates an understanding of data modeling (relationships, data types, tables, etc.) and analytics concepts (queries, reporting, association of data sources)
Collects and interprets data from various internal and external sources, including consumer enrollment and eligibility data, outpatient and inpatient provider services
Creates and runs weekly and monthly data reports, error reports, inpatient hospital claims reconciliation's, trending reports
Prepares and compiles data for routine and ad hoc quality, utilization management, and integrity reports
Demonstrates familiarity with modeling and reporting tools and how to use them during the analysis process (e.g. SQL and/or Business Objects tools-Crystal Reports)
Identifies linkages among the various technical groups, business leaders and user teams
Maps data (e.g. between source and target databases; mapping screen fields to database columns)
Assists business and systems analysts with business rule and data integration requirements according to established regulatory policies and procedures
Identifies and adheres to data validation rules and procedures as directed by the IT managers and RSN policies and procedures
Communicates effectively with team members, provider agencies, consultants, vendors and stakeholders
Creates work products using standard software packages (Word, Access, Excel)

OptumHealth 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 want more meaning in your career - as a clinician or a business professional - think of OptumHealth as your calling.

By providing 58 million Americans with information, tools and solutions, we are helping to guide them through the health care system, financing their health care needs, and enabling them to achieve their personal health and well-being goals.

At OptumHealth, you will perform within an innovative culture that's focused on transformational change in the health care system. You will leverage your skills across a diverse and multi-faceted business. And you will make contributions that will have an impact that's greater than you've ever imagined.

Qualifications

Qualifications:

2 years experience with Microsoft Excel and Access is required
Experience analyzing and reporting data is required
2 years experience with data analysis, tracking and trending, relational databases, data-marts and data management is required
Experience in claims processing is preferred
Behavioral Health background is preferred
Knowledge of SQL and/or Business Objects tools-Crystal Reports, and or other reporting tools is a plus
Excellent verbal and written communication skills; analytical, methodological and organization skills required
Experience with healthcare data management in the healthcare industry or behavioral health programs is preferred
Thorough knowledge of PC-based software programs, statistical applications and automated database management systems is preferred
Knowledge of functional policies, procedures, processes, standards is preferred
Math, accounting and/ or financial principles, workflow, benchmarking and /or evaluation processes is preferred
Bachelor's degree in Computer Science, Information Management Systems or related field or 5 years equivalent and relevant experience 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.

Job Claim Business Process

Primary LocationUS-WA-Tacoma

Organization Behavioral Sol - Public Sector

Schedule Full-time

Number of Openings 1