Optum Payment Integrity Jobs (NOW HIRING)

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us.

The Impact You'll Have

We are seeking an experienced Senior Business Analyst - Medical Coding Configuration to support Medicaid claims processing and payment integrity initiatives. This role focuses on analyzing, configuring, and maintaining medical coding and claims editing rules that drive claim adjudication outcomes, including payment, denial, and pended claim scenarios. The ideal candidate will have deep expertise in healthcare claims processing, medical coding methodologies, and claims editing configuration, with hands-on experience in Optum CES (Claims Editing System) and/or FACETS.

What You'll Do

• Conducts in-depth research and analysis. Identifies trends, emerging issues and recommends best practices to ensure maximum results and develops metrics.
• Documents metrics and process changes. Effectively analyzes, designs, develops, tests, debugs, implements, maintains and/or enhances new or existing systems through reporting and documentation.

How You'll Do It

• Participate in and coordinate individual projects and related activities to ensure project progresses on schedule.
• Maintains adequate communication regarding project status, risks, issues, and priorities with project sponsors and leadership.
• Acts as a liaison with internal partners and external partners to identify opportunities and needs and researches/develops implementation plans for meeting these needs.
• Responsible for representing the customer and/or stakeholder (internal/external) while collaborating with business and technical units.
• Serves as senior subject matter expert associated with content, processes, and procedures. May lead project teams and may provide training to lower level staff to achieve project milestones and objectives.
• Performs additional responsibilities consistent with the scope and level of the role, as assigned.

Required Skills & Experience

• 5+ years of related information technology professional experience. Bachelor's degree; in lieu of a degree, an additional two years of relevant experience beyond the qualifications listed above may be accepted.

Preferred Skills & Experience

• Optum CES (Claims Edit System) experience
• 5+ years of medical coding experience in lieu of Information technology experience.
• FACETS platform experience.
• Ability to communicate complex topics clearly and concisely, actively listen to anticipate stakeholder needs, and align others to drive informed decisions.
• Ability to analyze complex information, evaluate options, and work cross-functionally to drive resolution and prevent recurrence.
• Ability to effectively organize work, balance competing priorities, and manage time across complex assignments and competing deadlines.
• Proficiency with business technology platforms, systems, software, and tools.
• Understanding of business operations, processes, or domain context.
• Ability to analyze information and support business decisions, solutions, or process outcomes.

Role Designation

Teleworker Role designation definition: Teleworking is working full time remote. Hybrid is a minimum of 2 days onsite. Onsite is full-time onsite.

Compensation and Benefits

$90,800.00 - $120,300.00 - $149,800.00 Annual Pay is based on several factors which vary based on position, including skills, ability, and knowledge the selected individual is bringing to the specific job. We offer a comprehensive benefits package which may include: Medical, dental, and vision insurance Life insurance 401k Paid Time Off (PTO) Volunteer Paid Time Off (VPTO) And more To discover more about what we have to offer, please review our benefits page.

Equal Employment Opportunity Statement

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. Blue Cross of Minnesota is an Equal Opportunity Employer and maintains an Affirmative Action plan, as required by Minnesota law applicable to state contractors. All qualified applications will receive consideration for employment without regard to, and will not be discriminated against based on any legally protected characteristic. Individuals with a disability who need a reasonable accommodation in order to apply, please contact us at: talent.acquisition@bluecrossmn.com.