This role will prepare you for significant career growth as you shift to a gear you didn't know you had in you. So the contributions you'll make as a Data Analyst at Optum, the pride you will feel, the smile that will keep you company on your way home are all ways that you'll know what you do here really matters. It will be important. No, it will not be just important, it will be historic. That's why someday, you will look back at the things you achieved here and realize that you did your life's best work.(sm)The purpose of the Senior Operations Analyst is to support the Claims, Credentialing, System Configuration (Benefit, Provider, etc.), Provider Call Center, Claims Delegation Oversight, and Quality Assurance (Claims) departments under Network Operations. Duties include claims analysis, IKA configuration analysis, EDI analysis, User Acceptance Testing and Quality Assurance for all system patches / upgrades, operational reporting for monthly metrics, budgeting, and forecasting, troubleshooting for all departments as relates getting data into and out of the IKA system, etc. Additionally this role supports the entire encounter data submission process which is a collaborative effort among DataRAP, IT, and Claims. This position plays a major role in the development and implementation of core business systems and processes. Primary Responsibilities: Analyzes business needs, documents requirements and translates needs into functional, nonfunctional and / or technical specifications according to each department's needs Analyzes and extracts data from the Enterprise Data Warehouse (EDW) to report to internal and external customers Serves as a key resource to both IT and business units by providing data/analytical support, mentoring, guidance and technical expertise Designs, develops, tests, documents and maintains database queries for ad hoc reporting used in complex conceptual analyses for all departments within Network Operations and for external departments such as Finance (HCE) and IT Develops systematic reporting processes and procedures to ensure timely delivery of weekly, monthly, quarterly, annual and ad hoc reporting to management throughout the company and to Optum (metric reporting) Develop network adequacy reports including GeoAccess data extracting and mapping, comparing to Medicare Adequacy standards, and applying to current network status to identify gaps in WellMed network Develop credentialing reports, roster reporting, and all other ad hoc provider reports needed Delivers requirements, performs analysis, and evaluates downstream business, systems, process and / or organizational impacts Plans and assists with oversight of testing processes and activities including defect identification and resolution Advises the appropriate people on the implications of existing IT systems that can be applied to a problem. Identifies risks and issues, makes recommendations, and seeks approval on complex matters Provides subject matter expertise, reporting support and operational support to internal business partners. Collaborate with Optum CDQI on project EQMS Conducts focus group interviews, research initiatives and identifies best practice approaches. Evaluate workflows and develop tools to assist a variety of positions streamline their work to maximize efficiency Will ensure compliance of X12 transactions by running them through EDIFECS, WEDI, SNIP level validator Performs all other related duties as assigned
Required Qualifications: Associate's degree in a related field 4 or more years related experience in operations reporting and analytic capacity Proficient in SQL, Oracle, SSRS, ODBC, MS Access and MS Excel and / or equivalent data capture / reporting tools Excellent analytical and problem solving capabilities with special attention to accuracy and detail Proven ability to successfully conceptualize an initiative, develop a plan and execute the plan through implementation Experience in maintaining motivation to accomplish goals under stringent timelines Ability to interact one on one and consult with all levels of executive management Good analytical, logical and organization skillsPreferred Qualifications:Managed Care experience Beginning to intermediate proficiency using SQL Server Management Studio Ability to work with minimal guidanceCareers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 90,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm) 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. Job Keywords: Senior Operations Analyst, wellmed, San Antonio, TX, Texas
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.