Senior Technical Business Analyst - Prospective Payment Systems

Minneapolis, Minnesota
Dec 30, 2021
Mar 01, 2022
Employment Status
Full Time
Health Care that Starts with You!

Join a truly mission-driven organization! Independent, nonprofit UCare is recognized as one of the Minnesota's leading health plans. We provide more than 225,000 members across Minnesota and western Wisconsin with the health coverage plans and services they need to maintain and improve their health. The innovative coverage we create makes a difference for Medicare-eligible individuals, individuals and families enrolled in Minnesota Health Care Programs, such as MinnesotaCare and Medical Assistance, and disabled adults with special health care needs.

UCare is growing in size, membership, products, geographic coverage, and employees. We're an organization that's going places. Be part of a team that cares about you, be part of UCare.


Enter a highly collaborative environment where people are truly engaged, and feedback is valued. You'll enjoy a competitive salary and benefits, as well as a host of other perks, including a nationally recognized wellness program, and a bright, open, award-winning office space in Northeast Minneapolis just minutes from major freeways and retail centers.

At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.




UCare offers Medicare, Medicaid, Individual and Family health plans - powered by the hardest working people in the industry. Our people powered teams de-complicate, advocate and always go the extra mile to help our members. We serve with integrity, compassion and commitment to do right by members, providers and government partners. Above all, we come to work excited to provide members a path for the best health of their lives.


Working at UCare is more than a career; it's a mission. A mission that defines us as professionals, unites us as an organization and shapes how we interact with our members and each other. Employees join UCare and stay because of the opportunity to have a purpose-driven job.

Our strong culture has established UCare as a Star Tribune Top 150 Workplace for 12 consecutive years since the awards program began. It's a culture that embraces innovative ideas, strategic partnerships, and exemplary customer and provider experiences. Working at UCare is being a part of a people powered team dedicated to making a real difference in the lives of our members and communities.


Work Location: Work from Home, Hybrid or Standard

The health and safety of our employees, members, providers, and our community is our highest priority. Therefore, all new employees are expected to be fully vaccinated against COVID-19 prior to starting at UCare, subject to limited exceptions such as for a sincerely held religious belief or for medical reasons.

Position Description

This position is responsible for the support, testing, documentation, and coordination of all Optum Prospective Payment System (PPS) work from assigned Project(s) to run the business routine maintenance, break/fix issue resolution, claim pends and enhancements. Investigate, analyze impact, and resolve PPS-related issues and assist other departments in understanding how UCare utilizes Optum PPS and the rules, editors and polices embedded in the pricers and groupers. Preparation and maintenance of technical user manuals, system configuration documents and other technical reports will also be responsibilities of this role.

• Analyze, test, and support Optum PPS routine maintenance updates and custom requests in alignment with UCare products, legislation, policies, and procedures. Review Optum Release Notes, analyze, document, and test all updates.

• Support the evaluation of each release, documenting changes, assessing impacts, and seeking feedback from UCare stakeholders.

• Collaborate and work with Optum AMS Team and UCare technical resources, daily managing tickets, issue resolution, and overall support.

• Assist in the development of test scenarios for changes and/or projects. Support the timely resolution of open testing bugs and issues.

• Complete impact analysis with report requests, analyzing reports, and submitting claims reprocessing or adjustment requests as appropriate.

• Develop and maintain documentation, communicating changes as appropriate.

• Recommend and draft new and updated procedures to maximize the use of Optum PPS products to improve efficiency and claims payment accuracy.

• Research and respond to service requests in a prompt and timely manner.

• Inform leader and peers of changes that will impact UCare. Research and recommend methods to improve or implement necessary changes in a prompt and efficient manner.

• Develop and maintain good working relationships with the staff of other teams and departments including but not limited to CCO Configuration Team, Healthcare Economics, Provider Assistance Center, Provider Services, Coverage Policy and Government Relations.

• Monitor industry related standards, requirements and best practices including understanding CMS guidelines and researching regulatory guidance.

• Perform gap analysis and recommend technical solutions.

• Fulfill the role of a subject matter expert in all things PPS.

• Validate the functionality of the end product according to the functional specifications. Support Quality Assurance efforts.

• Other projects and duties as assigned.


Bachelor's degree in computer science preferred; demonstrated experience may be considered in lieu of degree.

Required Experience

Five or more years of experience as a Business Systems, Technical or Functional Analyst. Knowledge of all phases of software development and/or payment systems. Two or more years of in-depth experience with Optum PPS applications.

Preferred Experience

Experience in health care or managed care. Five years' experience with Optum PPS applications.


The UCare difference is our people power - employees actively working on the behalf of our members to get them access to the health care they need. We value and respect each individual's ideas and contributions, and provide the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, and a myriad of volunteer activities. If you're looking for an inclusive environment that celebrates your people power, helps you build on your strengths and gives you the opportunity to truly make a difference, we invite you to apply.

As an Equal Opportunity/Affirmative Action Employer, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.

JOB POST DATE: 12/29/2021

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