Capitation & DOFR Configuration Analyst - Remote

UnitedHealth Group•Los Angeles, CA

8d•$35 - $63•Remote

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. The Capitation & DOFR Configuration Analyst role is responsible for managing and configuring agreements, tables, and schedules within the Facets platform. This role requires a thorough understanding of Capitation or DOFR models, healthcare industry practices, and data analysis to ensure accurate payment processing and compliance with contractual terms. Important note: There are separate roles on the team focused on either Capitation or DOFR. Candidates do not necessarily need expertise in both areas to be considered. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week. 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.

Requirements

5+ years of experience in capitation configuration, claims administration, healthcare data analysis, or related roles
Understanding of healthcare regulations, capitation/DOFR models, and payment processes
Familiarity with data analysis tools and methodologies
Demonstrated solid analytical skills, attention to detail, and proficiency in healthcare management systems
Demonstrated excellent communication and collaboration skills
Proven flexibility and a high tolerance for ambiguity

Nice To Haves

Facets configuration knowledge
Proven ability to make independent decisions on behalf of the team by applying critical thinking skills without always having all the information
Demonstrated exemplary team skills and demonstrated ability to be a positive and productive team member. With the transformative nature of the work we are doing, we need someone who can be a team player due to the levels of collaboration involved

Responsibilities

Capitation Configuration Role: Set up and maintain capitation agreements in the Facets processing system, ensuring accuracy and adherence to contractual terms
DOFR Configuration Role: Setup and maintain DOFR agreements in the Facets processing system, ensuring accuracy and adherence to contractual terms
Data Analysis: Analyze capitation data to identify trends, discrepancies, and areas for improvement. Provide recommendations based on data findings
Compliance: Ensure capitation agreements are compliant with healthcare regulations and standards. Stay updated on changes in regulations and adjust configurations accordingly
Reporting: Generate reports on capitation payments, performance metrics, and compliance status. Present findings to stakeholders
Collaboration: Work closely with other departments, such as finance, provider relations, and IT, to ensure seamless capitation processes and resolve any issues
Documentation: Maintain thorough documentation of capitation configurations, processes, and changes. Ensure records are accurate and accessible
Training: Provide training and support to staff on capitation or DOFR processes and system use