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Sr Healthcare Economics Consultant

3 months ago

Eden Prairie, Minnesota, United States Optum Full time

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.

As the Optum Care National Risk Adjustment Healthcare Economics Team, we support risk adjustment efforts across our enterprise, primarily focused on Medicare Advantage Risk Modeling. We are internal analytics partners who provide expertise to our finance, operations, accounting and clinical leads to identify coding gaps, assess opportunity, forecast, and analyze risk. If you eat, breathe, and sleep risk adjustment like we do, then this is the right place for you If you're not a risk adjustment expert, but hungry, driven and willing to learn, we will help you become one of the best in class experts in the field.

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

As a Sr. HCE Consultant, you may assist with

  • Assist in complex analytic projects leveraging data from multiple sources to support Medicare Advantage Risk Adjustment programs, coding accuracy and clinical health outcomes for leadership. Look for opportunities to apply automation to facilitate regular reporting and replace repetitive tasks
  • Designing and documenting quality assurance plans, perform detailed quality checks on large data sets and research and resolve data issues
  • Reviewing complex SQL code and looking for opportunities to improve efficiency and accuracy
  • Performing complex ad hoc analyses related to Medicare Risk Adjustment using SQL on a SQL server and in Snowflake
  • Communicating findings to leaders and stakeholders (written or verbally) who may not have a data focus. Integrate feedback and continually refine analytics
  • Researching CMS Guidelines and healthcare dataset technical specifications to assist with model enhancements
  • Running and improving upon key data processes using large data sets
  • Multi-task, prioritize efficiently, and navigate a dynamic environment

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:

  • 5+ years of advanced analytics experience in Economics, Engineering, Statistics, Finance, Health Administration, Mathematics, or related field
  • Experience of synthesizing analysis into actionable and easy to digest insights
  • Experience of performing robust quality checks on large datasets and researching and resolving data issues.
  • Proven comprehensive analytical skills: data extraction, manipulation, visualization, and reporting
  • Proven advanced Excel skills (sorting, filtering, conditional formatting, pivot table/charts and advanced formulas such as: VLOOKUP, COUNTIFS, INDEX-MATCH, SUMPRODUCT, IF, IFERROR)
  • Proven intermediate to Advanced SQL programming skills (data querying, manipulation and transformation, table creation, complex joins across multiple sources, subquery, indexing, and summary reporting)

Preferred Qualifications:

  • 3+ years of experience in analyzing, reconciling, and summarizing healthcare administrative data such as medical claims, membership, MMR (Monthly Membership Report), MOR (Model Output Report), and encounter response data (MAO-002, MAO-004) etc
  • Experience in historical trend analysis and predictive modeling using statistical approach
  • Experience with Snowflake cloud database
  • Knowledge of CMS regulations and Medicare Advantage risk adjustment methodologies such CMS-HCC model (Hierarchical Condition Category), and risk score calculation

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, Washington, or Washington, D.C. Residents Only: The salary range for this role is $88,000 to $173,200 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves 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 - 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.