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  • Irvine, CA

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Risk Adjustment Project Specialist - Irvine, CA

UnitedHealth Group • Irvine, CA

Posted 15 days ago

Job Snapshot

Healthcare - Health Services
General Business, Health Care


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Job Description

Here, your performance, your ideas, your unique analysis will combine with a rich assortment of contributors to understand and shape the health care system. At UnitedHealth Group, you'll work with a team that has the creativity and passion to help build new health care solutions that meet emerging market needs. You'll get the opportunity to work with an elite team that goes beyond the usual analysis, they dig deeper knowing our goal is nothing short of transforming health care. Does the challenge of utilizing your analytical abilities on vital projects towards a larger strategic mission excite you?

As a Risk Adjustment Project Specialist, you'll have the opportunity to plan, develop, implement, and lead Risk adjustment projects and activities. This will all be done largely by providing data analysis to support, compile and report key information for operations and business objectives. This is a position that affords you the ability to drive processes and improvement initiatives. By gathering and documenting business requirements and utilizing your sharp analytical skills to fulfill the needs of the business and/or clients, you will have an impact on healing the health care system. Some people would call you a data geek, but at UnitedHealth Group that passion turned into information is used for decisions made by leadership. This is a challenging role that creates an opportunity to grow and develop while doing your life's best work.(sm)

Primary Responsibilities:

  • Support Risk Adjustment Physician incentive payment cycle and ensuring that timely payment is made each month. As part of this responsibility the position requires great attention to detail

  • Leading and supporting various Risk Adjustment initiatives such as expansion of screening clinic to additional locations and more broad deployment of screening equipment in contracted physician offices

  • Reporting of organizations performance on key metrics to all management levels

  • Ability to recognize ideas / initiatives to help the organization reach year end goals and communicate the downstream analysis of the idea/initiative

  • Gather and document business requirements

  • Analyze and interpret data to identify trends, patterns and opportunities for the business and clients

  • Communicate analysis and interpretation to appropriate audience

  • Maintains current knowledge of CMS-HCC and CDPS risk adjustment policies, procedures and best practices; develops and presents departmental materials

  • Support Physician Education efforts on CMS-HCC risk adjustment model, CDPS risk adjustment model, how to utilize available reports and tools, and other related projects and initiatives

Required Qualifications:

  • 1+ years of experience in the following areas:

    • Gathering requirements from the client / business and documenting

    • Analysis of business process and workflow and providing an evaluation, benchmark and/or process improvement recommendations

  • Experience and knowledge of ICD-10 CM codes

  • Intermediate level of proficiency with Excel, Word, and PowerPoint 

Preferred Qualifications:

  • Bachelor’s degree in Business, Finance, Health Administration, related field or equivalent work experience

  • Project Management Certification such as LEAN or working with Agile method

  • Healthcare Risk Adjustment experience

  • Experience and knowledge of CMS-HCC and CDPS risk adjustment

  • Ability to communicate analysis including trends and opportunities to clients and the business in writing and verbally

  • Ability to problem solve including multiple priorities and research conflicting and/or inaccurate data

  • Seeking an individual who is driven to meet goals and exceed expectations

  • Position requires the person to be an innovative thinker and excellent communication skills

  • Must have the ability to develop exceptional relationship building skills

  • Must be a team player and able to lead and manage multiple projects simultaneously

  • Critical thinking, analytic skills 

What's the first thing that happens when one of the most successful physician groups in Orange County comes together with a global leader in health care? Opportunity. With Monarch HealthCare joining OptumCare and the UnitedHealth Group family of companies, people like you will find increasing levels of challenge, impact and professional success. With a vibrant network of hospitals and urgent care centers, we're changing health care for the better by improving access to affordable, high quality care, and working together to improve the patient experience. That takes passion, commitment, intense focus and the ability to contribute effectively in a highly collaborative team environment. Are you with us? Learn more about this exciting opportunity to do your life's best work.SM



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: Provider, payments, payment cycle, risk adjustment, healthcare, project management, analysis, requirements, ICD-10, CMS-HCC, CDPS, Excel, Word, PowerPoint


Job ID: 2551_705998
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