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EDI BUS Consultant Analyst - Medicare/Medicaid Encounters - Telecommute
Virginia Beach, VA

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

Positions in this function have primary responsibility for requirements documentation for all aspects of Encounter Management.

Positions in this function conduct analyses, assist in the solutioning, and development of data maps both to load BHEMIS SQL database objects and for mapping processes from BHEMIS to HIPAA Compliant Implementation Guide (IG) and Customer Companion Guide (CG) Transaction documentation and/or other proprietary formats to meet Customer/client requirements as well as all associated documentation.

Generally work is self-directed for both prescribed and non-prescribed processes.
Works with less structured, new, highly complex issues.
Serves as BHEMIS Data Mapping Subject Matter Expert (SME).
Comfortable working in a dynamic, rapidly changing work environment.

Primary Responsibilities:

  • Demonstrate and apply knowledge of medical and/or behavioral health claims and general encounter processing and management best practices
  • Demonstrate and apply intimate knowledge of HIPAA transaction guides, data elements and use requirements
  • Demonstrate and apply knowledge of federally mandated Companion Guide guidelines and their use
  • Demonstrate and apply basic relational database concepts and familiarity
  • Conducts/updates/manages analyses and document transaction requirements based on IG/CG and proprietary format instructions
  • Identifies data gaps and manages remediation of same
  • Assists in the development/creation/documentation of data maps from SQL to HIPAA/proprietary transactions using ETL software
  • Conduct mapping/code audits of all maps prior to release
  • Creating, managing and running scheduled mapping/transaction generation jobs
  • Conducts research as needed using a variety of tools (SQL Management Studio, XMLSpy, UltraEdit, etc.).
  • Assists data and report analysts in developing data validation routines
  • Acts as primary liaison between BHEMIS and Customer/client production personnel
  • Demonstrate and apply a strong attention to detail
  • Creates various work products using standard software packages (Word, Excel, Visio)

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:

  • Bachelor’s degree
  • 4+ years of experience with medical or behavioral health claims processing
  • 2+ years of experience of MS Excel, Word, Visio
  • 1+ years of experience with T-SQL

Preferred Qualifications:

  • Experience working as a Business Analyst.

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $82,100 to $146,900. The salary range for Connecticut / Nevada residents is $90,500 to $161,600. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.

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

Company overview

10000+ Employees
Company - Public
Health Care Services & Hospitals
$10+ billion (USD)

Optum ratings

  • 69 %
    Recommend to a friend
  • 75 %
    Approve of CEO
  • CEO Andrew Witty
    Andrew Witty
    3,094 Ratings
  • Career Opportunities
  • Comp & Benefits
  • Culture & Values
  • Senior Management
  • Work/Life Balance

Optum reviews

  • "Able to be involved in many passion projects if you choose to do so; good work life balance." (in 2166 reviews)
  • "For ppl who just want good pay and basic work this is the best you can get" (in 2008 reviews)
  • "Benefits are good and they are large" (in 1278 reviews)
  • "Good management and people eccentric" (in 1203 reviews)
  • "Great company and people are all great" (in 1066 reviews)
  • "For few proj work is to much where we need to extend and no work life balance for women employees" (in 2166 reviews)
  • "pay is low; bonus on paper is high but in reality is much much lower" (in 2008 reviews)
  • "Benefits could be better and training" (in 1278 reviews)
  • "Poor management and too much micromanagement" (in 1203 reviews)
  • "they take advantage of people helping" (in 1066 reviews)

Optum – Why work with us

Optum benefits

3 Ratings

Employer summary

At UnitedHealth Group, your total health and well-being are important to us. That’s why we have comprehensive benefits and resources to help you be your best at work and at home. Some of the benefits that you and the ones you love will enjoy when you start a career with us include:

  • Health and well-being programs and services
  • Flexible work schedule and remote-friendly positions
  • Health, vision and dental benefits
  • HSA and FSA eligible plans
  • 401(k) savings plan
  • Childcare benefits
  • Short-term/ long-term disability coverage
  • Basic life insurance and AD&D
  • Employee stock purchase plan
  • Home office stipend for remote employees

Learn more

Employee benefit reviews

Most commented

  • Health Insurance(182 comments)

    "Good health insurance: Triple S"

  • Vacation & Paid Time Off(156 comments)

    "Good accumulation of vacation time"

  • 401K Plan(105 comments)

    "They do offer a retirement 401k plan"

  • Dec 5, 2023
    Current Patient Access Representative in Portland, ME, Maine

    No sick time. Have to use PTO

  • Dec 2, 2023
    Current Employee in Los Angeles, CA, California

    Plenty of learning opportunities, passionate leaders Fragmented system

  • Dec 2, 2023
    Current Employee in San Juan, PR, Puerto Rico

    PTO, Work from Home, Flexibility, Benefits package, etc.

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