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Senior Business Developer

2 weeks ago

Dublin, Dublin City, Ireland beBeeBusiness Full time €45,000 - €60,000

Optum is a global organisation that delivers care, aided by technology to help millions of people live healthier lives. This role will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best.

The work you do will be part of a culture guided by diversity and inclusion, with talented peers, comprehensive benefits and career development opportunities. You will have the chance to make an impact on the communities we serve as you help us advance health equity on a global scale.

In healthcare, evolution doesn't just happen. It takes innovation, imagination, and a passion for solving problems in new and better ways. And innovation is taking place at a lightning-fast pace every day. As part of our team, you will be expanding your skills and knowledge in this fast-paced environment.

Do you believe data can help reshape the future, and you find yourself loving the thrill of diving into challenging work? You will be working with an organisation that will recognise those talents, and you will have lots of growth potential.

As a key member of the Risk and Quality Operations (RQO) team, you will play an important role in delivering UnitedHealth Group's mission of helping people live healthier lives. The primary responsibility of this position will be to ensure that a member's risk adjusting claims are evaluated against their coded medical record encounters for the payment year.

The Senior Business Analyst will be responsible for processing, evaluating, and validating claims inventory to ensure the Claims Verification process meets the standard as set by the US department of Health & Human Services (HHS) for chart review. You will be challenged to make recommendations as to how performance can be continuously improved.

Join us where there has never been a better time to do your life's best work.

Schedule: Full-time position with standard working hours of Monday - Friday, 9am - 5pm.

Work arrangements include flexible work options and individuals who live and work in the Republic of Ireland will have the opportunity to split their monthly work hours between our Dublin or Letterkenny office and telecommuting from a home-based office in a hybrid work model.

Primary Responsibilities:
  • Track and manage Inventory within the EDPS system, Coordinate the deletion of invalid diagnosis codes from CMS systems (RAPS and EDPS) as soon as discrepancies are identified
  • Monitor CMS reports (e.g., MAO-004) to track which diagnosis codes were accepted, disallowed, or flagged for deletion, communicate findings and deletion actions to internal stakeholders and CMS as required
  • Ensure deletions are properly documented and traceable, including the reason for deletion and source of error
  • Track and report Delete Data Delivery results from Optum Insight's EDPS Application to clients
  • Implement proactive strategies to triage deletes and reduce audit risk before CMS initiates RADV (Risk Adjustment Data Validation) reviews
  • Demonstrate understanding of standard operating procedures, policies, and processes and how those impact business partners' operations
  • Assist with maintenance of SOP documentation, process documentation, and reporting controls to meet audit requirements
  • Develop and maintain relationships across the wider RQO and Risk, Quality and Network Solutions (RQNS) functions to facilitate collaboration and effective communication
  • Work as part of a team to drive innovation and performance improvements which translate into improved customer outcomes and process efficiencies
  • Conduct error remediation in advance of CMS/HHS deadlines
Required Skills and Qualifications:
  • Bachelor's Degree (or higher) OR equivalent experience
  • Proven experience in business/finance analysis/healthcare with foundational knowledge of Risk Adjustment
  • Demonstrated experience operating successfully in the absence of established procedures
  • Experience in Microsoft Office suite of products (Excel, PowerPoint, Power BI etc.)
  • Understanding of relevant computer systems and platforms (e.g.: reporting systems; financial systems; company shared drives; Knowledge Library)
  • Intermediate level of proficiency in SQL (Oracle, PL/SQL, SQL, SQL*Plus) with the ability to pull and analyze data, as well as update and alter internal tables
  • Intermediate level of proficiency with Excel (pivot tables, V or H look ups, data validation, creating internal/external reports)
  • Ability to research conflicting and/or inaccurate data and determine root cause
  • Ability to assist with Operational Readiness tasks such as client implementations
Benefits:

Work arrangements include flexible work options and individuals who live and work in the Republic of Ireland will have the opportunity to split their monthly work hours between our Dublin or Letterkenny office and telecommuting from a home-based office in a hybrid work model.

You will be rewarded and recognised 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 providing development for other roles you may be interested in.

We offer comprehensive benefits and career development opportunities.

Others:

UnitedHealth Group recognises the importance of diversity and inclusion in the workplace.

Our mission is to help people live healthier lives and make the health system work better for everyone.

At UnitedHealth Group, our goal is to provide quality services that are accessible and affordable for all.

So if you're looking for a challenging and rewarding role in a dynamic environment, then join us today