Job Description

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

Our Product Development and Management groups are vital to our success and are leaders in driving the future growth of UnitedHealth Group. Success in these careers relies on many factors-your ability to deal with ambiguity, your ability to adapt and embrace change, and a long-term commitment to making health care better for everyone.

This Senior Capability Analyst position is responsible for researching, developing, and implementing requirements for the Medicaid product as defined by National and state policy. This position will work closely with the application teams in ensuring that requirements are correctly defined and administered.

You\xe2\x80\x99ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Accurately interpreting national and local Medicaid reimbursement policies and coding guidelines for utilization in Optum coding products including Claims Manager and Claims Edit System products
• Extensive experience with interpreting correct coding policies and medical terminology
• Ability to research source information from CMS with an emphasis on Medicaid policies
• Develop documentation to identify sources of edits
• Develop and maintain Medicaid specific edits including development, testing and maintenance to meet quarterly deliverables
• Working closely with application development to ensure proper claims processing
• Reviewing, researching, and responding to client issues and concerns
• Anticipates customer needs and proactively develops solutions to meet them
• Audit existing rules as well as maintaining ongoing testing for new development
• Identifies solutions to non-standard requests and problems
• Solves moderately complex problems and/or conducts moderately complex analyses
• Works with minimal guidance; seeks guidance on only the most complex tasks
• Translates concepts into practice
• Provides explanations and information to others on difficult issues
• Coaches, provides feedback, and guides others
• Acts as a resource for others with less experience
• Assesses and interprets customer needs and requirements

You\xe2\x80\x99ll 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:

• 5+ years of work experience (claims processing, abstracting, coding auditor)
• 5+ years of experience with Medicaid local and national coverage determination policies
• Experience creating professional documentation such as writing business requirements, proposal, clinical requirements, etc.
• Proficient experience with MS Word, Excel, Outlook
• Proficient technical writing skills

Preferred Qualifications:

• Bachelor\xe2\x80\x99s Degree
• Coding Certification (examples: CPC, CCS, RHIT, RHIA, etc)
• Experience with SQL
• Auditing / testing experience
• Experience with clinical requirements for claims processing applications
• Experience presenting to senior level management
• An extensive background in medical claims processing, appeals resolution, facility / provider coding experience or reimbursement policy
• Proven excellent written and verbal communication skills
• Proven organizational skills with ability to be flexible and work with ambiguity
• Demonstrated ability to manage and prioritize deliverables

Careers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.

California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The salary range for California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island or Washington residents is $67,800 to $133,100. 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\xe2\x80\x99ll find a far-reaching choice of benefits and incentives.

*All employees working remotely will be required to adhere to UnitedHealth Group\xe2\x80\x99s Telecommuter Policy

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone\xe2\x80\x93of every race, gender, sexuality, age, location and income\xe2\x80\x93deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes \xe2\x80\x94 an enterprise priority reflected in our mission.

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.

UnitedHealth Group