Key skills
Microsoft SQLEDI 837 ClaimsHIPAA X12 EDI 837 ClaimsHIPAA X12 277 Acknowledgment transactionsEncounter Management systemsClaims Payment systemsEDI testing and validationMicrosoft ExcelCMS claims processing guidelinesDHCS claims processing guidelinesData-driven analysisStrategic thinkingSQLLeadership
About this role
Optum is a healthcare company focused on improving health care through integrated health programs. They are seeking a Senior Business Analyst to guide improvements in encounter data operations and optimize efficiency within the Finance department by utilizing technical strategies and SQL skills.
Responsibilities:
- Monitor daily end-to-end encounter submissions from in-house system to health plans
- Correct rejected encounters in accordance with CMS and DHCS claims processing guidelines and industry standards
- Write and generate reconciliation reports as required by health plans
- Proficient in developing ad hoc scripts to provide insight and analysis for leadership
- Proactive in analyzing trends of rejected encounters; conducting root cause analysis and scope to prioritize escalations
- Manage key relationships with health plans, clearinghouses, and internal stakeholders to drive effective prevention, resolution, and escalation of encounter errors
- Resource for EDI validation as required for 837 resubmissions or user testing
- Prepare and update department documentation and training materials
- Lead special projects and additional responsibilities as needed
Requirements:
- 5+ years of experience in Microsoft SQL query development and reporting
- 2+ years of experience within the healthcare data environment - (e.g. encounters, eligibility, provider, claims)
- EDI 837 production support and maintenance experience including editing and correcting X12 837 transactions for resubmission to trading partners
- EDI testing and validation experience
- Experience using Microsoft Office, Excel (e.g. dashboards, pivot tables, formulas, v-lookup)
- Ability to travel up to 10%
- Proven knowledge about importance of encounter data reporting and impact on revenue
- Demonstrated understanding of claims billing cycle and reimbursement process a plus
- Based in Southern California
- All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy