Senior Provider Data Specialist

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. Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by diversity and inclusion, career growth opportunities and your life's best work.^SM

This position works under the supervision of the Quality Manager of Provider Data load Quality. Positions in this function are responsible for various activities related to the provider network database which may include any or all of the following: database maintenance, reporting and extracting data for various reports and analyses, initiating database improvement. Develops and maintains standards for database integrity and quality assurance, coordinates corrective activities to clean database and retain users, and manages communication processes with other departments regarding database improvements. Conducts audits and provides feedback to ensure complete and accurate provider network data. May be responsible for representing the provider network area on company Provider Data projects, reporting and tracking provider calls and complaints, or for the support, coordination, and production of the paper directory cycles.

In this role, the challenges are varied and the pace is fast. You'll need to work independently and be a problem solver as you you'll be working with a wide range of credentialing providers as well as assisting in provider relations, medical billing and quality management.

The statements listed below are not intended to be all inclusive of the duties and responsibilities of the position. Based on leadership decisions and business needs, "all other duties as assigned" will be expected for each position.

• Works independently
• May act as a resource for others
• Extensive work experience within provider data function
• Work is frequently completed without established procedures
• May coordinate others' activities, may audit peers and complete calibrations
• Applies knowledge/skills to a range of moderately complex activities
• Demonstrates great depth of knowledge/skills in provider data function
• Sometimes acts as a technical resource to others in provider data function
• Proactively assists in the identification of problems and solutions to non-standard requests
• Solves moderately complex problems on own
• Works with team to solve complex problems
• Plans, prioritizes, organizes and completes work to meet established objectives
• All other duties as assigned

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

Primary Responsibilities:

• Provide input/suggestions into database or system design based on process, information, or regulation changes, or client requirements
• Utilize database systems and tools to enter and/or research provider data
• Receive the data from multiple inbound sources (e.g., spreadsheets, email, claim)
• Interpret instructions that accompany the inbound data
• Interpret data in order to identify data anomalies and discrepancies
• Review system results to determine whether keyed data is correct
• Contact internal data submitter to verify/clarify data to be entered
• Pull and organize data correctly to answer specific business questions
• Research multiple databases to pull in the correct or needed information
• Lead or participate in applicable projects related to design, entry, and/or support of provider data
• Lead or participate in applicable projects related to business rules and procedures
• Work within applicable tools to verify/clarify data to be entered
• Communicate within the applicable tools to convey audit results to internal data loader
• Pull and organize data correctly to answer specific business questions
• Research submitted data to ensure the right business processes have been followed and/or determine appropriate actions or decisions (e.g., change process; modify strategy)
• Identify root causes of data issues and engage appropriate areas to correct causes
• Develop and/or contribute to rules and procedures to meet business or regulatory requirements
• Maintain current knowledge of business strategies, rules, and procedures (e.g., attend and apply training)
• Demonstrate an understanding of and apply business strategies, rules, and procedures as appropriate (e.g., determine whether to reject or accept data entry)
• Analyze submitted data to ensure the right business processes have been followed and/or determine appropriate actions or decisions (e.g., change process; modify strategy)
• Lead or participate in applicable projects related to business rules and procedures or business process improvements
• Analyze data in order to identify data anomalies and discrepancies
• Identify root causes of data issues and engage appropriate areas to correct cause
• Identify risks and support risk remediation
• Supports quality improvement initiatives through research and analysis
• Identify and update gaps in quality audit processes
• Identify gaps in provider data loading processes or instructions, when conducting a provider data audit and notifying the Quality SME and Quality Manager
• Maintain monthly census of Provider Data Loaders (PDL) for audit purposes

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:

• High School Diploma/GED (or higher) OR 2+ years of audit and data analysis experience in healthcare quality related activities
• 1+ year of audit and data analysis experience in healthcare quality related activities
• 1+ year of provider/data entry experience
• 1+ year of auditing experience
• 6+ months of experience working directly with tracking, trending, and reporting on metrics
• 6+ months of experience in documenting processes
• 6+ months of quality experience
• 6+ months of experience with/knowledge of the health industry
• Intermediate level of proficiency with MS Excel

Preferred Qualifications:

• Associate's Degree OR 2+ years of higher education and equivalent experience
• Six Sigma Certification - White Belt
• 2+ years of auditing experience
• Experience in quality auditing
• Experience in VACCN (Veteran Administration Community Care Network)
• Healthcare experience
• Basic knowledge of process flow mapping and process narrative documentation

Soft Skills:

• Excellent interpersonal, communication, and writing skills
• Strong computer skills with emphasis on Excel, Access, PowerPoint, and Visio
• Strong analytical skills
• Demonstrated data analysis experience
• Ability to work in a fast paced dynamic environment
• Ability to generate, analyze, and synthesize quality data
• Ability to organize quality data in appropriate reporting format
• Ability to lead teams

Careers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

California, Colorado, Nevada, Connecticut, New York, New Jersey, Rhode Island or Washington Residents Only: The hourly range for California, Colorado, Connecticut, Nevada, Washington or New York City residents is $18.80 to $36.78. 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.

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.

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