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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
Primary Responsibilities:
- Performing Integrated System Testing activities
- Develop claim scenarios to test CES facility and physician edits, as well as maintain the existing test suite of claims
- Develop and implement effective physician and/or facility claim scenarios that test updates and change initiatives for all standard, customized, and repricing templates
- Maintain a robust test suite of physician and facility claims for effective and efficient testing of edits for all lines of business
- Collaborate with internal and external business partners to identify and remediate defects within edits
- Actively participate in cross-team meetings to support the client's requests
- Apply Quality Assurance audit results for future integration and system development and testing
- Identify process improvement opportunities and actively participate in process improvement teams
- Ensure completion of assigned tasks by posted deadlines
- Participate in new hire training and work with mentors
- Support post deployment validation
- Comply with the Software Development Lifecycle (SDLC) and agile Methodologies
- Understand Testing, Stage and production environment concepts
- Establish the right strategies for Test Data
- Adhere to compliance checks, e.g., HIPPA, Quality control guidelines and practices
- Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so
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Eligibility
To apply to an internal job, employees must meet the following criteria:
- SG 25 & SG 26 can apply
- SG 25 will move to SG 26; SG 26 will move laterally
- Performance rating in the last common review cycle of "Meets Expectations" or higher
- Not be on any active CAP (Corrective Action Plan) or active disciplinary action
Required Qualifications:
- Bachelor's Degree and 5+ years of healthcare reimbursement experience, either via direct work in the market (with insurers, hospitals, physicians, etc.) or via technology solutions being sold into the healthcare market
- 4+ years of claims processing experience or equivalent knowledge
- 1+ years of reimbursement policy experience
Preferred Qualifications:
- CPC or other coding certification
- 2+ years of user acceptance testing experience
- 6+ months of specific CES claim edit testing experience
- Proven solid analytic, technical, and problem-solving skills
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.