Job details
Job type full-time
Full 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 getLeading edge technology in an industry that`s improving the lives of millionsHere, innovation isn`t about another gadget, it`s about making health care data available wherever and whenever people need it, safely and reliablyThere`s no room for errorJoin us and start doing your life`s best work.(sm)
The rules analyst is responsible for researching, defining, and implementing clinical and client requirements and guidelines for the genomics payment managerThe rules analyst will create edits to be managed centrally within the optum content platform to standardized content managementThis position will work closely with the application and product teams to ensure requirements are correctly communicated and administered.
Primary responsibilities:
Act as a liaison between various impacted operation teams including other key stakeholders to confirm the scope of a business rule request
Gather, analyze, and document business rule requirements and design the business rules
Identify potential areas where existing business and operational policies and procedures require change and/or where new ones need to be developed and make recommendations for improvement in those areas
Recognize, analyze, and document gaps between current state and the desired outcome
Create and/or maintain rule requirement matrix, data object models, process models and decision tables
Support platform projects
Create, document, and maintain content
Provide clinical support to potential and current clients
Anticipate customer needs and proactively develop solutions to meet them
Independent decision making related to correct coding and common practice standards
Ability to research source information from cms and other third-party sources
Research and create detailed edits with clinical perspective
Present information at clinical meetings or executive meetings
Review, research and respond to client issues and/or concerns
Working closely with application development to ensure proper claims processing
Provide clear description of problems / issues for medium to high complexity problems
Solves complex problems and develops innovative solutions
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:
Undergraduate degree or equivalent experience
3+ years of experience with medicaid, medicare and/or commercial coverage determination required
2+ years of experience in gathering and authoring business requirements and solutions for large scale complex project
2+ years claims processing experience or equivalent experience
Experience creating professional documentation such as writing business requirements, proposal, clinical requirements, etc.
Preferred qualifications
Experience and knowledge with business process rules management processes, rules and/or tools
Experience working with multiple stakeholders in a matrix type environment to achieve project deliverables required
Experience developing basic test scenarios and supporting user acceptance testing
Careers with optum Here`s the ideaWe built an entire organization around one giant objective; make health care work better for everyoneSo 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 serveOptum, 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 potentialFor you, that means working on high performance teams against sophisticated challenges that matterOptum, incredible ideas in one incredible company and a singular opportunity to do your life`s best work.(sm)
Colorado residents only: the salary range for colorado residents is $64,800 to $116,000Pay is based on several factors including but not limited to education, work experience, certifications, etcAs of the date of this posting, in addition to your salary, uhg offers the following benefits for this position, subject to applicable eligibility requirements: health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; employee assistance program; pto; and employee-paid critical illness and accident insurance.
*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 workplaceCandidates are required to pass a drug test before beginning employment.
Job keywords: genomics rule specialist, telecommute, telecommuter, telecommuting, work at home, work from home, remote
