Optum, Inc. EDI BUS Consultant Analyst – Medicare/Medicaid Encounters


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.


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