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Job Details

UnitedHealth Group

Associate Director Risk Adjustment Data Analytics - Remote


Data Analyst


Santa Ana, California, United States

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)

If you want to achieve more in your mission of health care, you have to be really smart about the business of health care. Challenge yourself, your peers and our industry by shaping what health care looks like and doing your life’s best work.

Clinical Performance (CP) is charged with effectively implementing, monitoring, and executing on clinical documentation, quality, and affordability programs that promote patient health while improving the provider practice experience with a special focus on Medicare Risk Adjustment and HEDIS. Clinical Performance processes on a national level by providing support in all markets served by OptumCare Delivery.

People say change is hard. We say so what? We're in the business of making health care more affordable, simpler and easier for people to access. And we need really smart business professionals who can help us. As a Senior Business Analyst, you'll design processes and project implementations and diagnose process improvement opportunities as you develop innovative solutions that will affect millions. If that sounds energizing to you, join us today

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

Primary Responsibilities:

  • Develop/Support Solution Strategies and Plans
  • Oversee management of key Risk Adjustment data operation processes within CP Risk Adjustment Operational data environment
  • Develop and Oversee enforcement of SLA and controls to ensure timely and accurate data receipt from vendors
  • Perform data mapping and data gap analysis on vendor layout to standard CP layout
  • Perform appropriate research/analyses to help develop solutions to support CP Risk Adjustment Operational processes
  • Create business requirements to drive development of solutions to support CP Risk Adjustment Operational processes
  • data environment
  • Oversee level 1 triage of data processing and manage the escalation and mitigation plan for any issues
  • Perform data analysis and provide insights based on the analysis and findings
  • Develop/Manage Client Relationships
  • Own and manage data relationships with the Wraparound and coding vendors
  • Manage SLAs and follow vendor management protocols to ensure compliant and timely data
  • Manage data implementation and production support for weekly /monthly data ingestion process with vendors
  • Establish productive relationships and clear lines of communications with CP team members relevant CDO stakeholders
  • Demonstrate Market and Industry Knowledge
  • Stay current on important issues in the healthcare industry.
  • Demonstrate knowledge of CMS Risk Adjustment and ICD-10 coding requirements and regulations. Stay abreast of changes/updates in relevant policies, procedures and regulations
  • Leverage knowledge of the market and industry to drive service excellence and Risk Adjustment performance

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
  • 5+ years of Risk Adjustment experience
  • 2+ years of experience in operations, and/or business process improvement initiatives
  • Experience working with data implementation and understanding of data layouts
  • Experience working in Agile development environment
  • Technical competency with experience creating and applying data analytics to solve business problems
  • Solid SQL skills, ability to perform effective querying involving multiple tables and subqueries
  • Ability to work with business stakeholders and document functional and business requirements
  • Knowledge of Software Development Life Cycle methodologies. Working knowledge of data mining principles: predictive analytics, mapping, collecting data from multiple data systems on premises and cloud-based data sources a plus
  • 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

Preferred Qualifcations:

  • Excellent verbal and written communication skills
  • Customer/consultant relationship management and collaboration skills
  • Ability to understand process workflow and triage production issues
  • Ability to work with vendor data team and enforce SLAs
  • Ability to apply business knowledge to findings and provide insights

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, Nevada, or New York City Residents Only: The salary range for Colorado residents is $97,300 to $176,900. The salary range for Connecticut/Nevada/New York City residents is $97,300 to $176,900. 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 employees working remotely 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.