Analysis and documentation Identifies and defines business requirements Constructs workflow charts and diagrams Validates resource requirements and develops basic cost estimate models Manages complex requirement conflicts, and assists associate and intermediate level Business Analysts with moderately complex to complex requirement conflicts Implements, modifies, tests, an

Provide coding quality auditing services to ensure compliance with Optum and CMS coding guidelines and accuracy of coding data reported Maintain compliance with Optum Coding Guidelines/policies. The minimum productivity goal is set by project, with minimum 96% coding accuracy rate required You'll be rewarded and recognized for your performance in an environment that will

This role will provide coding quality auditing services to ensure compliance with Optum and CMS coding guidelines and accuracy of coding data reported. Must maintain compliance with Optum Coding Guidelines/policies. The minimum productivity goal is set by project, with minimum 96% coding accuracy rate required. You'll be rewarded and recognized for your performance in an

Serve as a member of the operations senior leadership team and advise executives on external trends, problems, and activities to facilitate both short and long range strategic plans to improve operational performance and enhance growth. Set the vision and strategic plan for OptumRx PBM operations & client services and support scaled operations through solid partnership ac

Conduct MS DRG and APR DRG coding reviews to verify the accuracy of DRG assignment and reimbursement with a focus on overpayment identification Expert knowledge of and the ability to identify the ICD 10 CM/PCS code assignment, appropriate code sequencing, present on admission (POA) assignment, and discharge disposition, in accordance with CMS requirements, ICD 10 Official

Pricing support for OptumInsight Payer software and services product suite Pull and manipulate operational and financial data Maintain and enhance pricing models and templates Effectively work with cross functional teams that include Finance, Sales, Product and Operations Develop a strong understanding of the business mission through effective interactions with upper mana

Oversee detailed data analytics and financial projections (e.g., MicroStrategy, Excel) and translate findings to operational stakeholders Perform project / program management activities, such as monitoring client scope, creating and tracking deliverables, creating status reports, identifying and mitigating risks, managing resource plans, and monitoring successful achievem

IT Pillar financial responsibilities spanning across multiple long term MPP clients totaling billions of dollars in TCV Scaling financial operations related to IT Delivery across MPP clients Monitoring of financial spend in comparison to contract to ensure that no financial leakage occurs Work with operational leaders to monitor financial performance compared to deal pro

Help process provider credentialing and enrollment applications and re applications including initial mailing, review and loading into the database tracking system Conduct audits and provide feedback to reduce errors and improve processes and performance Demonstrate great depth of knowledge/skills in own function and act as a technical resource to others Solve complex pro

Identify appropriate assignment of ICD 10 CM and ICD 10 PCS Codes for inpatient services provided in a hospital setting and understand their impact on the DRG with reference to CC/MCC, while adhering to the official coding guidelines and established client coding guidelines of the assigned facility Identify appropriate assignment of CPT and ICD 10 Codes for outpatient sur

Perform financial clearance processes by interviewing patients and collecting and recording all necessary information for pre registration of patients Educate patients of pertinent policies as necessary i.e., Patient Rights, HIPAA information, consents for treatment, visiting hours, etc Verify insurance eligibility and completes automated insurance eligibility verificatio

Works on complex, major or highly visible tasks and projects as a project team member, sometimes as a project lead Expertise in multiple technical environments and possesses business knowledge that spans one or more business areas Participates in project planning processes Identifies project tasks and leads or assists with project timeline estimations Works with other tea

Interact with customers to gather support data to ensure invoice accuracy and also work through specific billing discrepancies Educate customers regarding the availability of receiving invoices and remitting payments through online applications Resolved concerns related to patient balances on their accounts. Handles inbound calls. Routes accounts for review and resolution

Responsible for greeting and welcoming patients in person. Provides a standard registration process by collecting demographic and financial data and enter information into a electronic medical record. Primary Responsibilities Greets and welcomes patient in person Collects demographic and insurance information Checks in or interviews patient to complete appropriate paperwo

Meet with clients that lack funding for SNF stay; assist with/facilitate application to Medical Assistance, application for Long Term Care and/or application to State Medical Review Team (SMRT) including securing forms, documentation and verifications required Submission and tracking of Medicaid applications Contact county and state offices regarding application status; p