Remote Hcc Risk Adjustment Coder Jobs in Sugar Land, TX

Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation's leading health care organizations and build your career at one of our 40 locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing together.  

The Healthcare Finance (HCF) department exists to monitor and improve the financial performance of Kelsey-Seybold's (KS) product lines and health plans. The HCF Analytics team is a customer service-focused department providing consultation to the KS executive team as well as to select operational and functional departments. The HCF Analytics team works closely with internal and external partners to identify revenue and cost savings opportunities, support new product and business development, ensure regulatory compliance, inform contract negotiations and complete reconciliation of incentive arrangements, claims, capitation, and premium payments with other payers, vendors and/or government entities.

The HCF department is adequately staffed by highly skilled, motivated and inquisitive individuals that deliver complex analysis of financial and utilization data to support revenue enhancement and identify cost savings opportunities. The Supervisor will oversee the work of a team of 1-3 analysts and closely collaborate with the Manager and Director of Healthcare Finance to oversee and provide financial data, reporting and other actionable information to the HCF Management Team and other departments regarding relevant business units, processes, products and/or service lines. The Supervisor is responsible for ensuring timely receipt and load of external data required for the team's analysis and reporting.

If you are located in Pearland, TX, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Oversight and production of recurring financial reports, financial reconciliations, and analysis required to understand the key drivers of the relevant business unit or service line 
• Helping to develop and implement the systems and processes that are the foundation for reporting and analysis
• Coordinating the delivery of analytical support to internal customers including the Central Business Office, Pharmacy Services, Business Planning, Accounting, Managed Care Contracting, Claims, Marketing, and Utilization Management departments and partnering with the Business Intelligence team to automate and improve reporting
• Presenting findings and recommending solutions to internal and external customers and KS Executive team

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• 5 years of experience in data analysis, decision support, medical economics, healthcare informatics, or managed healthcare
• 3 years of programming experience in SQL, SAS or similar application language
• 2 years of experience supervising or managing teams and/or projects
• Experience writing, debugging and documenting complex queries against relational databases
• Experience participating in/leading system design and implementation initiatives
• Demonstrated ability to create and implement analysis/modeling that converts raw data into actionable business insights

Preferred Qualifications:  

• Experience in the healthcare industry and familiarity with healthcare systems (e.g., enrollment/eligibility, capitation, claims payment, etc.) with a Managed Care Organization (MCO)
• Experience with Medicare Part C or Health Insurance Marketplaces highly desirable, particularly with CMS risk adjustment models
• Experience in the healthcare industry with understanding of data in healthcare organizations (including claims data, ANSI 5010 837 data specifications, ICD10, Medicare Advantage, Health Insurance Marketplace, capitated payment models)
• Experience with Statistical Software (including SAS, R, Minitab, SPSS)
• Experience with reporting tools (including Crystal Reports and Microsoft Access)
• Knowledge of medical insurance products and basic underwriting concepts
• Familiarity with EPIC and Clarity reporting data warehouse

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 - $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable.

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.

OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.