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Have you been working with Utilization Management systems and/or Claims Payment systems and their associated HIPAA X12 EDI 278 Authorization transactions? Are you looking for an opportunity to expand your experience working with EDI 278 integrations in the health care industry? We have a great opportunity for an individual to lead trading partner integrations from end to end working with our proprietary Medical Management system (MMS) and connecting it to a variety of Claims systems (FACETS, IDX, Xcelys and IKA, just to name a few). The EDI Solutions Analyst ensures that the technical integration between the MMS and Claims systems is seamless to our end users for all Authorization Data using an EDI 278 transaction. Our technical environment includes an Azure cloud-based database solution where we talk to a PostGres SQL databases for our core application database technology along with leveraging Snowflake SQL to interact with our reporting data warehouse for conducting EDI 278 statistical analysis on the health of our EDI 278 integrations as well as conducting deep dive transaction research for troubleshooting integration issues. You will use your existing database SQL skills to broaden your understanding of the required data mapping necessary to stand up the EDI 278 transaction for our trading partners. Can you articulate and interpret business requirements and compare them against the industry standard technical implementation guide of the X12 278 transaction giving trading partners real-world scenario variances of the allowed usage for the specific loop-segment-element of the EDI 278 transaction? If this sounds like what you have been doing and something you want to continue to build upon your existing in-depth knowledge of how the EDI 278 (Authorization/Referral) transaction works in health care, please read on and apply as we have an opening on our team and would like to hear from you about your existing specialized experience in this space.

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

Primary Responsibilities:

• Monitor Daily EDI Transaction Processing

• Troubleshoot and Resolve any EDI processing issues

• Implementation Team Resource for EDI Mapping, Validation and Testing as required

• Prepare and update program documentation, job aides, and other artifacts as requested

• Scheduled and ad hoc auditing of various systems and databases to support prior authorization transactions

• Process review, data analysis and measurement for various programs related to prior authorizations, claims and member eligibility

• Create process and data flow diagrams for the various programs/projects as assigned

• Preparation of reports as needed by management

• Identification and communication of processing issues to management

• Prepares and coordinates presentations, trainings, etc; used as an educational resource

• Implementation of new technologies and processes (includes testing and follow up)

• May involve some interfacing with clients, managed care customers, IT resources and others when needed

• Assignment of special projects as needed

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:

• 2+ years of experience within the healthcare data environment - eligibility, provider, claims, etc.

• 2+ years of experience with data mapping and workflow documentation

• 2+ years of Healthcare EDI Transaction Knowledge and expertise

• 2+ years of Specific EDI X12 ANSI 278 Transaction expertise

• 2+ years of EDI transaction mapping experience

• 2+ years of EDI Production Support and Maintenance experience

• 2+ years of EDI testing and validation experience

• 2+ years of Healthcare IT experience

• 2+ years of experience with SQL (manipulating data and queries) - Relational databases like MySQL, MS SQL, DB2

• Experience using Microsoft Word (creating and editing documents), Microsoft Outlook (email and calendar), Microsoft Excel (pivot tables, formulas (vlookup, xlookup, match, etc..) and Microsoft Visio (process/data flow diagrams)

Preferred Qualifications:

• Experience working with cloud-based solutions and services

• Knowledgeable about claims billing practices and process management concepts - this may include knowledge of CPT coding or reimbursement processes, 3rd party provider enrollments, claims submissions, EDI and HIPAA transactions and/or accounts receivables

• Proven ability to write clear technical and functional specs

Soft Skills:

• Solid organization skills and attention to detail

• Excellent communication skills, both verbal and written, with the ability to interact with various levels of resources internally and externally

Telecommuting Requirements:

• Dedicated work area established that is separated from other living areas and provides information privacy

• Ability to keep all company sensitive documents secure (if applicable)

• Lives in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

California, Colorado, Connecticut, Hawaii, Nevada, New York, New Jersey, Rhode Island, or Washington Residents Only: The salary range for this role is $70,200 to $137,800 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.