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Risk Adjustment Analyst - Audit Services - Telecommute

UnitedHealth Group

Eden Prairie, MN
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Job Details

739894 Risk Adjustment Analyst Audit Services Telecommute

Risk Adjustment Analyst - Audit Services - Telecommute (739894)

Position Description

If you want to achieve more in your mission of health care, you have to be really smart about the business of health care. Challenge yourself, your peers and our industry by shaping what health care looks like and doing your life's best work.(sm)

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

The Risk Adjustment  Analyst Services is responsible for managing and overseeing the end-to-end execution of Retrospective services within the Risk, Quality and Network Services (RQNS) segment. The Analyst will be responsible for creating, maintaining and publishing P&L forecasts for all assigned services. Management and oversight of multiple levels of matrixed staff and multiple functions / departments across one or more business units will be required. The Analyst will develop and implement service enhancements or ideate new services as required. This person will work across multiple operational teams to ensure proper establishment of services and operational excellence. The Analyst will provide leadership to manage service definition, requirements creation, operational and technical considerations, pricing, contracting, and operational effectiveness oversight to ensure proper execution of services.  Further, this individual will solve for complex business issues and represent the concerns of RQNS and the client in escalated management, legal, compliance and client satisfaction issues.

Primary Responsibilities:
  • Owns end to end process for assigned services
  • Functions as subject matter expert to client facing teams, sales and internal resources
  • Identifies and resolves technical, operation and organization issues. Escalates to Senior Management as appropriate
  • Monitors project performance against established service level agreements to determine overall effectiveness of program. Makes necessary changes and identifies opportunities for new programs, program consolidation, efficiencies or expansions to existing programs/services
  • Creates, reviews, and maintains operational workflows to ensure they are up-to-date and operationally efficient. Maintains appropriate internal and external documentation as necessary for each assigned service
  • Monitors appropriate controls for each process / handoff within the service to ensure adherence to compliance requirements
  • Assists and provide necessary information/inputs (volumes, vendor cost estimates, resource estimates) for accurate pricing of services as well as risk management protections and caveats
  • Manages P&L for assigned services and generates required financial documentation for revenue projections and CBAs
  • Demonstrate understanding of and adhere to relevant policies, procedures, and regulations for assigned services
  • Stays abreast of changes / updates in all relevant policies, procedures and regulations within the risk adjustment segment (Medicare Advantage,  Affordable Care Act, Medicaid)
  • Provides training and education to internal stakeholders on relevant policies and procedures to ensure proper execution of service
  • Communicates and coordinates with and/or helps internal / external partners interpret contractual requirements in order to ensure compliance with contractual and regulatory stipulations
  • Works with other key business, product and strategy team members to enhance and implement changes to existing or new services as appropriate / necessary. Develops and assists in creating pilots and/or POCs (Proof of Concepts) necessary to provide strategic direction for new services

Required Qualifications 

  • 2 or more years of experience working with Medicare Advantage and/or Affordable Care Act (ACA) risk adjustment principles and concepts
  • 2 or more years of client facing experience 
  • 2 or more years of experience with RADV audits (Medicare and/or ACA)  
  • Experience with managing a budget and/or P&L 
  • Intermediate Proficiency with Excel and PowerPoint 
  • Travel up to 10% 

Preferred Qualifications 

  • Undergraduate degree
  • Understanding of Risk Adjustment programs and their interdependency with CMS and HHS requirements
  • Product or strategy experience in either healthcare, insurance, and/or risk adjustment fields
  • Experience with audit or compliance programs
  • Basic underwriting, pricing and/or risk management principles  
  • Project / program management experience

Soft Skills:

  • Multi-tasking, ability to manage at macro level and also dig deep into issues for successful resolution
  • Strong written and verbal communication skills
  • Relationship management skills; ability to communicate sensitive information in a positively received fashion. Ability to build and maintain relationships inside and outside the organization via telephonic means

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:  RADV audits (Medicare and/or ACA), Medicare Advantage and/or Affordable Care Act, client facing, telecommute, Excel, Powerpoint, Telecommute, Remote, Work from Home


Job Details

  • Contest Number739894
  • Job TitleRisk Adjustment Analyst - Audit Services - Telecommute
  • Job FamilyBusiness Operations
  • Business SegmentOptumInsight

Job Location Information

  • Eden Prairie, MN
    United States
    North America

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelManager
  • ShiftDay Job
  • TravelNo
  • 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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