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Concept Research Quality Lead - Franklin, TN / Eden Prairie, MN / Frederick, MD or Telecommute Considered

UnitedHealth Group

Franklin, TN
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746196 Concept Research Quality Lead Franklin TN Eden Prairie MN Frederick MD or Telecommute Considered

Concept Research Quality Lead - Franklin, TN / Eden Prairie, MN / Frederick, MD or Telecommute Considered (746196)

Position Description

As the Concept Research Quality Lead, you will be responsible for maintaining a Quality Program on the team to improve our outcomes. The role is responsible for evaluating and monitoring all analyst documentation, data pull criteria, GOAL PPTs, and BRD’s. The role continually assess to ensure top opportunities are accurately being tracked on a daily basis. In addition, the lead will consistently trend our partner feedback, sample results and error report results. The lead will manage all tracking of E2E outcomes to evaluate the variance in our handoffs. The Quality Lead’s impact will be monitored through weekly/monthly quality reports will be produced as well as through weekly 1:1 discussions.


If you are located in Franklin, TN, Eden Prairie, MN or Frederick, MD, you will have the flexibility to telecommute* as you take on some tough challenges. Nationwide Telecommute will also be considered, but the above locations are preferred.

Primary Responsibilities:
  • Maintain a Quality Program on the Concept Research Team
  • Closure/Referral Documentation Analysis (PAWS & Lead Folder Documentation Assessment), BRD ,GOAL Deck, Data Pull Criteria Assessments
  • Continually Evaluate Top Opportunity Report to ensure accuracy
  • Trending of Rule Delivery Feedback, Error Report Results, Sample Validation Results, E2E Concept AAO/HAO Results
  • Post Referral and One Time Opps Variance Assessments

Required Qualifications:

  • BA/BS degree or equivalent experience
  • 2+ years of experience in a quality role
  • 3+ years of healthcare experience (billing, coding, auditing claims)
  • 3+ years of data experience identifying, analyzing, and effectively communicating trends in highly complex data
  • Knowledge of Medicare, Medicaid and / or Commercial health plan and payment methodology
  • Maintains working knowledge of CMS rules and regulations and knowledge of procedure and diagnosis codes (CPT, ICD-9/10 coding, HCPCS and DRGs)
  • Strong computer skills:  Access, Excel, Visio, PowerPoint. Specifically, an advanced level of proficiency working with MS Excel including formulas, pivot tables, charts/graphs for data analysis and presentation

Preferred Qualifications:

  • Bachelor’s degree or equivalent experience
  • Experience in the health care industry (Medicare, Medicaid, Commercial) with deep exposure to Payment Integrity
  • Knowledge of UHC systems as well as desk top applications
  • Experience working in a matrix  and highly adaptive environment handling tight deadlines
  • Understanding of SAS programming and SQL coding
  • Knowledge of statistical methods used in the evaluation of healthcare claims data
  • Auditing or trending for outliers experience
  • Strong facilitation, critical thinking, problem solving, decision making and analytical skills
  • Highly collaborative and consultative style with ability to establish credibility quickly with all levels of management across multiple functional areas
  • Self-managed, self-starter with the ability to prioritize and support multiple concurrent projects and meet tight delivery timelines
  • Strong project management approach with excellent critical thinking and problem solving skills
  • Exceptional verbal and written presentation, communication and negotiation skills

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world?s large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)


*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer 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.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords: quality, claims, research, data analysis, ICD, coding, SAS, SQL, Franklin, TN, Tennessee, Eden Prairie, MN, Minnesota, Frederick, MD, Maryland, Telecommute, Telecommuter

Job Details

  • Contest Number746196
  • Job TitleConcept Research Quality Lead - Franklin, TN / Eden Prairie, MN / Frederick, MD or Telecommute Considered
  • Job FamilyHealthcare Economics
  • Business SegmentOptumInsight

Job Location Information

  • Franklin, TN
    United States
    North America
  • Other LocationsEden Prairie, MN
    Frederick, MD

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelIndividual Contributor
  • ShiftDay Job
  • TravelYes, 25 % of the Time
  • Telecommuter PositionYes
  • Overtime StatusExempt

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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