Monitor Daily EDI Transaction Processing Troubleshoot and Resolve any EDI processing issues Implementation Team Resource for EDI Mapping, Validation and Testing as required Prepare and update program documentation, job aides, and other artifacts as requested Scheduled and ad hoc auditing of various systems and databases to support prior authorization transactions Process

Perform coding compliance and quality audits in support of Optum Insight Provider's Compliance Program and client expectations Analyze and interpret documentation from medical records Clearly document audit findings and calculate billing error rates Provide feedback and education as appropriate depending on findings Articulate audit findings appropriate to the audience Pr

Perform coding compliance and quality audits in support of Optum Insight Provider's Compliance Program and client expectations Analyze and interpret documentation from medical records Clearly document audit findings and calculate billing error rates Provide feedback and education as appropriate depending on findings Articulate audit findings appropriate to the audience Pr

Extract, analyze, aggregate, and interpret data Perform quantitative analysis of health care claims utilization and cost data Participate in client relationships and communications Prepare information for clients, build reports, and assist with project scheduling and coordination of tasks Develop, review, and analyze detailed data sets leveraged for client reporting/analy

Raise the bar on excellence in execution in terms of quality, timeliness, and scalability Take accountability for key engineering metrics of the platform specifically availability, reliability, and security Develop and evolve engineering and product roadmap of UAIS Collaborate across various lines of businesses as well as global locations to ensure smooth execution of cri

Deploy machine learning models and establish automated data pipelines between cloud and on premise environments Design and implement integration and unit tests to ensure system reliability and performance Continuous integration and continuous delivery of production code Develop code and system level documentation Work with the broader technical team to scope engineering m

Read and interpret complex professional provider contracts Conduct Audits in Partnership with the Internal Teams Create reports and analyses using Facets data to validate pre and post configuration changes made by self or others Conducts Configuration Analysis (by reviewing configuration set up and identifying root cause of findings) Collaborate with Claim Ops to Validate

Lead engineering teams for conceptualizing, designing, developing, and maintaining vital elements of UAIS Platform Raise the bar on excellence in execution in terms of quality, timeliness, and scalability Take accountability for Key Engineering Metrics of the platform namely Availability, response time metrics, Time to Value and Time to build Develop and Evolve Engineerin

Provide presentations and demonstrations to customers and prospects of our products after thorough discovery incorporating value statements and benefits to Physicians, Administrators, Clinical Staff and C Level Executives Provide staffing and participation in product areas for tradeshows and product fairs Strategize with the Sales Team on a strategy to win Provide trainin

Collaborate with executive leaders and business units to identify and understand their reporting and analytics needs, ensuring alignment with organizational goals. Manage the deployment of cloud based data solutions and business intelligence tools to enhance reporting capabilities and support data driven decision making. Design and develop efficient data pipelines, data w

This is a remote position you may sit anywhere in the US Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a cul

Provide Epic product function, design, build, and testing expertise and experience for assigned Epic module related to Epic Beacon and EpicCare Ambulatory , or outpatient clinical applications Collaborate with end users to design and build the Epic system in a timely and professional manner and make corrective configuration or enhancements Lead small to medium complexity

Develop and implement AI and machine learning strategies to drive healthcare solutions. Design plan and prioritize experimentation of machine learning and deep learning models Process and transform source data to be used in machine learning pipelines, leveraging distributed computing environments and parallel processing approaches. Build robust machine learning pipelines

Conduct applied research experiments, build and test machine learning and deep learning models Implement and design novel machine learning and deep learning approaches inspired by relevant literature Build robust machine learning pipelines to support production processes Implement online learning methods to optimize ML models in prospective pilot scenarios using approache

Bring traditional actuarial skills to provider organizations as the health care market continues to evolve, including Assist in developing innovative strategies, value based contracts, and innovative risk based arrangements Develop, conduct, and evaluate studies on pricing, utilization, and health care costs for our broad range of provider clients Prepare, forecast, and a