Schaumburg, IL – Telecommute
Reporting Analyst – Schaumburg, IL
Location: Schaumburg Illinois United States
Division:OptumRx Prior Auth & Appeals
Contest Number: 818275
Family: Business Operations
Function: Business Process & TQM
JobLevel: Individual Contributor
Shift: Day Job
Overtime Status: Non-exempt
Reporting Analyst-PA Governance to join the Prior Authorization Governance Team in the Schaumburg, IL office. In this role, will serve as the performance guarantee (PG) subject matter expert during oversight and delegation audits performed by various clients. This reporting role is designed to mitigate risk in the areas of data validation, efforts for PA and Appeals including quality control for adherence to contractual agreements surrounding processing turnaround times and program requirements. Clinical validation includes review of prior authorization cases for clinical decision-making based on individual plan formulary and requirement and patient demographics. The analyst(s) will ensure compliance to various regulations based on lines of business and plan design.
Work independently to analyze claim data against documented plan design
Ability to understand and utilize RxClaim in order to verify potential coding errors
Isolate any claim anomalies with independent testing
Ensure system correction is accurately completed if necessary
Review potentially impacted claims for financial liability.
Practice the appropriate escalation process if necessary
Make ongoing recommendations to improve upon the audit process and procedure
Analyzes and investigates root cause of non-compliant cases.
Create and Maintain SharePoint for focus area
Responds to routine or standard governance, compliance and PG inquiries.
Support short and long term operational/strategic business activities – by developing, enhancing and maintaining operational information and models.
Perform Utilization Licensing Review
Update and Monitor Updated Policy and Procedure Compliance
Create and Maintain Corrective Action Plan (CAP) Documentation
1+ years of Pharmacy Benefit Management (PBM) and/or healthcare experience specifically working with a RxClaim adjudication system, a pharmacy claims data system, and/or Rx Claims.
Proven experience performing data and variance analysis and data mining/working with large amounts of data
Intermediate proficiency level of experience utilizing Excel
Beginning knowledge of utilizing Access
Excellent verbal and communication skills
Demonstrated ability to work productively and proactively in a dynamic, fast paced and constantly changing environment
Experience as a Pharmacy Technician
Financial analysis experience
Working with and understanding medical terminology
1+ year’s Prior Authorization experience
UnitedHealth Group is working to create the health care system of tomorrow.
Already Fortune 6, we are totally focused on innovation and change. We work a little harder. We aim a little higher. We expect more from ourselves and each other. And at the end of the day, we’re doing a lot of good.
Through our family of businesses and a lot of inspired individuals, we’re building a high-performance health care system that works better for more people in more ways than ever. Now we’re looking to reinforce our team with people who are decisive, brilliant – and built for speed.
Come to UnitedHealth Group, and share your ideas and your passion for doing more. We have roles that will fit your skills and knowledge. We have diverse opportunities that will fit your dreams.
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration f…
Insurance Claims , Medical & Health , Operations , Analyst