Algorithm Manager
About the position 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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. As a Long-Term Support Services (LTSS) Algorithm Manager, this leadership position is responsible for the identification, development, and presentation of new medical cost savings algorithms on behalf of our clients. This position will assess new analytic opportunities based on data insights by leveraging tools, regulations, industry trends and claims analysis. This highly trained industry expert will work with internal and external business constituents to determine opportunities for savings to meet target goals. In addition, the candidate will collaborate with cross-matrix teams, leadership, compliance, legal, and other Program Integrity stakeholders to support meeting client contractual obligations. You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.
Responsibilities
- Serves as primary point of contact for client regarding Algo workstream
- Identify analytic savings initiatives that drive specific and measurable results, building Algo concept pipeline and providing timely and meaningful client updates
- Participate in analytical, investigative work in support of post-pay algorithm development
- Algo Lead providing oversight and direction for Algo workstream staff
- Serves as a leader/ mentor to staff supporting algorithm workstream
- Coordinate assignments and review work performed by others
- Establish solid relationships with internal and external stakeholders to define, align, and deliver program integrity initiatives in support of assigned clients
- Present data findings with rerun algos and new algo ideas during internal and external meetings
- Recommend changes to current product development procedures based on market research and new trends to support algorithm ideation
- Propose new claims edit opportunities to client based on analytic trends
Requirements
- 3+ years of experience analyzing claims data in support of analytic/algorithm development
- 3+ years of experience developing analytics specifically for detecting FWA, utilizing analytics solutions using data warehousing tools such as SQL/Oracle and writing data criteria requirements
- Advanced working knowledge of Microsoft Office (Excel, PowerPoint) and use of Pivot tables
- Solid knowledge of federal health care requirements for proper claims billing and a firm understanding of medical terms and procedural coding (CPT, ICD, HCPCS, DRGs)
- Proven to be a self-starter with the ability to support multiple projects and meet delivery timelines
- Proven to be highly collaborative communication skills with ability to make presentations and establish credibility quickly with leadership across multiple functional areas
Nice-to-haves
- Advanced degree in health care or data science
- Coding certification through AAPC or AHIMA
- 3+ years Program Integrity experience
- 2+ years of experience developing Medicaid/Medicare data analytics
- 2+ years of Supervisory/Manager experience
- Federal/State regulatory health care compliance experience
- Long Term Support Services (LTSS) claims data and audit experience
- Advanced level proficiency with SQL and writing data logic criteria
- Expert with statistical methods used in the evaluation of healthcare claims data
Benefits
- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution
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