Advisory Services Analyst - RCM

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 culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

We are looking for an experienced RCM Analyst with a strong understanding of Revenue Cycle Management (RCM) processes and technical expertise in healthcare data standards. The role involves working on RCM cycle, EDI transactions, claims adjudication, and reporting/KPI development. Candidates should have either a technical background with reporting experience or RCM domain experience as a Product Owner/Business Analyst.

Primary Responsibilities:

• Analyze and interpret EDI 835/837 transactions for claims and remittance processing
• Work on RCM cycle processes including claims adjudication and reimbursement methodologies
• Develop and maintain RCM KPIs and dashboards, extracting relevant fields from EDI messages
• Collaborate with product teams for RCM product implementation on the provider side OR act as a Business Analyst/Product Owner for RCM solutions
• Understanding of integration of HL7 modules (Registration, Clinical) with RCM workflows
• Provide insights and recommendations to improve revenue cycle efficiency and compliance
• Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

Required Qualifications:

• Knowledge of Claims Adjudication and different reimbursement methods (Fee-for-Service, Capitation, DRG, etc.)
• Solid understanding of Revenue Cycle Management (RCM) processes
• Understanding of HL7 standards and modules that integrate with RCM (Registration, Clinical)
• Proficiency in SQL and reporting tools (Power BI, Tableau, or similar)
• Proven expertise in EDI standards (835 - Remittance Advice, 837 - Claims)
• Proven ability to extract and transform data from EDI messages for reporting
• Proven solid analytical and problem-solving skills

Preferred Qualifications:

• Experience in RCM product implementation on the provider side
• Experience as Product Owner or Business Analyst in RCM domain
• Familiarity with clinical and financial system integration
• Proven exposure to healthcare interoperability standards and integration workflows

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.