Job Description

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.

The Manager of Electronic Data Interchange (EDI) is accountable for overseeing the implementation of EDI technical standards, identifying EDI solutions to business needs and overall process improvement. Processing and creation of EDI files is critical to the company’s success. This position is responsible for directing the day to day operations involving the development, implementation and ongoing maintenance of the HIPAA 837 (claims), 835 (remittances), 276/277 (claims status inquiry and response), 278 (referral/prior authorization) EDI transactions and any other appropriate EDI transactions. This position will have responsibility for planning, implementing and managing HIPAA EDI projects relating to these transactions, including end-user contact, analysis, design, mapping, programming, training and documentation. Develops, maintains and provides technical expertise in order to transfer knowledge, and delivers knowledge transfer to appropriate personnel for skill development.

This position leads a team in analyzing the information and prioritizing the requirements to gain understanding of the business needs and to provide recommended solutions. This individual acts as an internal resource for consultation to the business to provide expertise and possible solutions to resolve reporting needs.

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

Primary Responsibilities:

• Oversee the processing of encounters from multiple Optum applications, including the design and development of data extractions for 837 files. Ensures the completion of all scheduled loads of data from numerous input sources
• Manage the Paid Claims Inload process and assists the Data Warehouse team with data incorporation to that application for reporting purposes
• Administer appropriate testing and audits of data loads to verify the accuracy of data elements
• Manage all 837data loads to vendor handling P4P and Medicare 5 Star submissions
• Responsible for the development of EDI policies and procedures related to the data validation of the encounters, definitions of core data set elements, data transfer specifications, process controls, report generation and information dissemination
• Create mapping and documentation for import and export processing of proprietary and ANSI electronic data files
• Direct the development and implementation of encounter specialist analysis capabilities. Retain skilled staff which will effectively deliver well reasoned, data supported and professionally presented solutions to business questions in such areas as encounter rejects, error corrections, and data validation as well as analytical forecasting
• Work with management to understand the goals and needs of the organization. Work with clients, clearinghouses, health plans and the department teams to specify, develop and provide accurate reporting output with multiple delivery formats
• Oversee the generation of accurate and timely ad hoc reports
• Conduct system and integration testing, including regression testing, for Quality Assurance purposes
• Lead a team as a manager and individual contributor to develop SQL and automation of data extract routines, as well as some SSRS and Tableau development
• Proven research, analytical, communication, and time management skills
• Solid interpersonal, motivational, planning, coordination, communication, organizational, problem solving, decision-making, and conflict resolution skills. Must be able to address all levels of employees and customers
• Remain responsible for updating self on ever changing information to ensure accuracy when dealing with customers

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:

• 5+ years progressive experience in health care industry with at least one year supervisory responsibilities
• Ability to manage client expectations and deliver exceptional products to assist in optimizing patient care and office management
• Superior project management, staff management and leadership skills
• Proven record of developing and retaining qualified staff
• Technical competence and experience with the oversight, development and maintenance of complex database structures
• Demonstrated experience with development of EDI and business analysis capabilities within a relevant healthcare organization
• Demonstrated competence with Transact SQL including but not limited to database design expertise, ETL (extraction, transform, loading) skill set, SSRS configuration and support, Tableau dashboard products and high level of technical competence
• Proven ability to successfully lead a technical group, to hold subordinates accountable for results, and to anticipate needs and solve problems

Preferred Qualifications:

• Fluid in various ANSI formats
• Solid project management and organizational skills
• Excellent problem-solving and troubleshooting abilities
• Ability to lead cross-functional teams
• Solid communication skills (technical and business-facing)
• Excellent written, verbal and interpersonal communication skills

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

The salary range for this role is $89,800 to $176,700 annually based on full-time employment. 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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

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

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