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Implementation Provider Data Lead - Telecommute

Company: UnitedHealth Group
Location: Las Vegas
Posted on: September 22, 2022

Job Description:

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 is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm) The Implementation Provider Data Lead is responsible for various activities related to coordinating the load of the provider network data for new markets and expansions at OptumCare. Activities will include: provider roster data inventory management, loading fallout resolution, reporting and extracting data for various reports and analyses, managing provider adds/terms/change transactions, initiating process improvements, and validation that 100% of data received has been loaded for claim readiness. These activities may involve using advanced SQL query knowledge including complex joins, along with manipulating data in Excel using formulas, vlookups, and pivot tables. Implementation Provider Data Analysts will interact with external and internal partners to understand the provider network strategy and intent, and communicate progress and risks. Other duties include developing and maintaining standards for claims system integrity and quality assurance, and coordinating corrective activities as it relates to provider data. The employee may work with other functional areas/teams to understand and aid in the implementation of requirements, analyze performance, and troubleshoot any existent issues. This may include comparing and reconciling data from different sources in Excel files, Access databases, and back-end data in our claims platform (Facets). You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. - Primary Responsibilities:

  • Manage initial provider roster & dual maintenance updates from multiple payors (CDOs)
  • Partner with Contract Management Expert and PDM Operations to load Directly Contracted Providers
  • Coordinate and validate mass uploads for demographics and pricing attachment using SQL validation techniques
  • Audit providers loaded to claims system end to end and are accountable to own any issue resolution
  • Communicate a variety or provider statuses directly to Provider Lead, using SQL techniques to query data from Facets (claims platform)
  • Support Unit testing and End to End (UAT) testing with provider loading to downstream environments
  • Collaborate with Eligibility to ensure PCPs are loaded accurately
  • Monitor Claims pends post 1/1 Implementation to analyze, trend, and root cause all potential gaps from provider loading - 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 experience in provider data management / provider data operations
    • 4+ years data analysis experience from either professional or academic experience
    • 3+ years of root cause analysis with E2E research and remediation experience
    • Experience using the National NPI Registry -
    • Experience performing root cause analysis on internal and external data and processes to answer specific business questions and identify opportunities for improvement
    • Advanced knowledge in provider data structure: Provider Taxonomy, Demographics (service, billing, remit address), Provider Group Dynamics, Principles of Pricing Structures for Providers, Understanding minimum required provider information
    • SQL knowledge, including experience working with relational databases and writing queries
    • Intermediate to expert level proficiency in MS Excel (pivot tables, formulas) and PowerPoint
    • Ability to extract, manipulate and process value from large, disconnected datasets
    • Solid analytic skills related to working with unstructured datasets Preferred Qualifications:
      • Experience with claims loading applications (CSP Facets, Cosmos, Nice, Pulse) -
      • Experience with or knowledge of Medicare or health insurance programs
      • Experience with Facets
      • Experience in the California commercial and government market place -
      • Previous experience with MS Visio
      • Previous experience working within a highly matrixed corporate setting
      • UAT experience including the ability to write test scripts
      • Business analysis experience including gathering requirements and providing recommendations
      • Ability to build processes supporting data transformation, data structures, metadata, dependency and workload management
      • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation Soft Skills:
        • Attention to detail
        • Solid organizational and interpersonal skills
        • Solid analytical skills for complex problem solving and develop root cause analysis
        • Ability to build relationships and work effectively in a virtual global team environment
        • Exceptional written and verbal communication skills
        • Ability to work independently with rapid learning curve
        • High energy and ability to work in a fast paced environment
        • Ability to work in a fast-paced, dynamic, rapidly changing environment
        • Solid aptitude for working in a production-driven environment
        • Constantly meet established productivity, schedule adherence, and quality standards while -maintaining good attendance
        • Ability to problem solve issues, including multiple priorities and research conflicting and / -or inaccurate data
        • Solid customer orientation, communication (written and verbal) and presentation skills
        • Solid analytical mindset and problem-solving skills
        • Excellent communication, time management, problem solving, organizational, and -analytical skills
        • Demonstrated ability to establish and maintain a professional working relationship with a -wide variety of individuals coming from diverse backgrounds
        • Experience with verbal and written correspondence with all levels of an organization To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment 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, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $66,100 to $118,300. The salary range for Connecticut / Nevada residents is $72,800 to $129,900. 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.

Keywords: UnitedHealth Group, Las Vegas , Implementation Provider Data Lead - Telecommute, Other , Las Vegas, Nevada

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