Laboratory Healthcare Economics Consultant - Telecommute U.S.

Company: UnitedHealth Group ( Learn More )

General Information
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Job Description The Healthcare Economic Consultant position requires a strong analytical skillset, data analysis and healthcare claims expertise (HCFA/UB) and will involve learning about solutions to detect incorrectly paid laboratory claims for all UHC segments (Medicare, Medicaid and Commercial) and claim platforms.  The role is responsible for utilizing all data mining tools (i.e. SAS, Self Service, SQL, Excel, etc.) to complete complex healthcare data queries to identify aberrancies, trends, outliers within claim data.   This role will focus on developing laboratory concepts in partnership with our Analytic and Operation partners to identify and research potential claims hypotheses; size concepts for potential opportunity and savings; and when confirmed, present the findings for solution approval.  This position requires excellent communication skills in partnership with our client.  An understanding of healthcare payment methodologies and policies as well as coding is recommended.

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

Researching and developing potential claim overpayment hypotheses
Responsible for utilizing data mining tools (i.e. SQL, Access, Excel) in order to analyze data to support of their hypothesis
When opportunity is confirmed, the analyst will present the findings for solution approval in a clear and concise manner utilizing data reports and summaries to support their concept
An understanding of healthcare payment methodologies and policies as well as coding is necessary
Required Qualifications:

3+ years of experience in healthcare (billing, coding, auditing claims)
3+ years of data analysis experience
3+ 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)
Knowledge of Medicare, Medicaid and / or Commercial health plans and payment methodologies
Knowledge of procedure and diagnosis codes (CPT, ICD10 coding, HCPCS, APC and DRGs)
Skill in financial management/assessments, looking for overpayments
Strong project management approach with excellent critical thinking and problem solving skills
Exceptional communication and negotiation skills, presentation skills
Self-starter with the ability to support multiple concurrent projects and meet delivery timelines
Strong computer skills: MS Outlook, Access, Word, PowerPoint and Excel (including vlookups, pivot tables)
Preferred Qualifications:

Bachelor’s degree
Education in laboratory medicine
Experience in laboratory coding, billing and compliance, Pathology CPT codes
Knowledge of the full range of clinical and anatomic laboratory tests
Knowledge of SAS/SQL/Toad/Aqua DataCareers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system 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
*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: Recovery resolution, lab tech, laboratory, technology, medical, healthcare, data, claims processor, telecommute, telecommuter
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