Key skills
Healthcare DataRegulatory EnvironmentOptum EASYGroupOptum Web ServicesOptum WebStratOptum Payment System InterfaceOptum Rate ManagerMedicare Hospital Facility Claims PricingHomegrown Claims SystemsTrizetto FacetsNetworXks PricerQNXTHealth Rules PayerIKA ClaimsBurgess SystemsEpic Tapestry3M Claims SystemsHealth Plan Facility Contract ConfigurationClaims SystemTechnical Workflow DocumentationOperational Workflow DocumentationSoftware ConfigurationSoftware CustomizationSQLRESTful Web ServicesHealthcare Claims DataProspective Payment SystemsDRGAPCOCEESRDCAHCMGRUGRBRVFacility Claims ReimbursementMedicareMedicaidCommercial Claims ReimbursementMicrosoft WordMicrosoft ExcelMicrosoft PowerPointMicrosoft Visio.NETIISPythonPostmanRESTfulCommunicationProblem Solving
About this role
Optum is a global organization dedicated to improving health outcomes through technology. They are seeking a Senior Business Systems Analyst to ensure effective delivery of maintenance, integration, and configuration efforts while supporting client needs and enhancing operational efficiency.
Responsibilities:
- Ensures successful installation, implementation, configuration and integration
- Work with Optum customers and vendor partners on configuration, use, and troubleshooting of Optum Web Service and Payment System Interface Cloud solutions
- Apply analytical / quantitative approach to problem solving
- Experience on obtaining and using PPS data for troubleshoot and analysis
- Comfortable and actual experience with statistical concepts to assist with PPS claims analysis
- Utilize communication skills to influence and negotiate
- Utilize one's solid interpersonal skills to work with all levels of management across all functional areas, as well as, business partners through internal entities
- Work within client ticketing system to track escalated issues, input new issues or answer issues sent in by other teams. Communicate any responses back to client and ensure understanding of the content
- Implement changes as needed and outlined in contract
- Work directly with Optum colleagues and customers to document and deliver Client PPS payment system methodology education needs
- Work directly with Optum colleagues and clients to document and deliver Client requirements for Optum PPS product training
- Works directly with customers to define other project requirements, provide assistance to answer questions related to project results
- Assist as needed with other Reimbursement Solutions projects Engage with dedicated clients either VPN or Remote, WebEx to apply updates or Troubleshoot issues using documentation from Regulatory
- Supports Optum Business Partners with technical implementation and integration questions. Offers recommendations for interface improvements from a technical perspective
- Compile Documentation: Processes and Procedures (including but not limited to Clients specific tracking, network configuration, rules of engagement)
Requirements:
- 5+ years of experience working in a healthcare data or regulatory environment
- 3+ years of experience with installing, troubleshooting, and using Optum's EASYGroup, Web Services, WebStrat, Optum Payment System Interface, and/or Rate Manager
- 3+ years of experience in pricing Medicare hospital facility claims (inpatient and outpatient)
- Claims system experience - Homegrown claims system (specify), Trizetto Facets, NetworXks Pricer, QNXT, Health Rules Payer, IKA Claims, Burgess Systems, Epic Tapestry, 3M preferred
- Experience breaking down information and developing solutions
- Health plan experience in facility contract configuration, claims or IT
- Experience documenting client operational and technical workflow
- Experience configuring and customizing software solutions
- SQL experience writing queries, navigating DBs, and researching data
- Experience with installing, troubleshooting, and navigating RESTful Web Services
- Experience with healthcare claims data, PPS concepts, UB04 and HCFA 1500 claim content
- Proven experience with using .NET and IIS
- Basic knowledge and understanding of Prospective Payment Systems - includes DRG, APC, OCE, ESRD, CAH, CMG, RUG, RBRV
- Facility claims reimbursement knowledge - Medicare, Medicaid, Commercial
- Intermediate knowledge and usage of with Microsoft Word, Excel, PowerPoint, Visio
- Some SQL experience
- Python experience
- Experience in API's
- Experience in Postman