Associate Director Payment Integrity - Telecommute

Company: UnitedHealth Group Inc.
Location: Minnetonka
Posted on: June 8, 2021

Job Description:

Tough challenges? We know a thing or two about those. When you're on a mission to help people live healthier lives, the stakes couldn't be higher. As an Associate Director Payment Integrity, you will help rewrite the future of the health care system. You'll analyze data and deliver bold, business-savvy ideas to impact the lives of millions. Along with ground-breaking challenge, you'll have the support and resources of a Fortune 7 company. Join us.

You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Implementation and management of Payment Integrity Programs
• Ability to lead a team of Payment Integrity associates across multiple Payment Integrity Pillars, and Care Delivery Organizations (CDOs) to meet departmental savings goals
• Analyze, review, forecast and trend complex data, reviewing the analysis and interpretation of others' work
• Develop and implement effective / strategic business solutions through research and analysis of data and business processes
• Support short- and long-term operational/strategic business activities through analysis
• Manage working relationships with multiple payment integrity vendors
• Maintain and track performance tracking and savings reports to senior leadership
• Build out departmental and incremental savings goals

Are you up for navigating a complex matrix of business units and teams? We share a near obsessive desire to outperform and outdo our own achievements across our entire global business landscape. It's going to take all you've got to create valuable solutions to improve the health care system.

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:

• Undergraduate Degree or equivalent work experience
• Experience working as a leader, with direct reports
• 5+ years of experience in the health care industry, in auditing, claims processing, payment integrity, claims configuration
• 4+ years of experience using claims platforms such as UNET, Pulse, NICE, Facets, Diamond, etc.
• 2+ years of experience conducting or managing comprehensive research to identify billing abnormalities, questionable billing practices, irregularities, and fraudulent or abusive billing activity
• Experience with Fraud, Waste, & Abuse (FWA) programs, or working within a Special Investigations Unit (SIU)
• Proficiency in performing financial analysis / audit including statistical calculation and interpretation
• Proficiency in various claims payment methodologies; to include capitation, fee-for-service, DRG, percent-of-charge, and OPPS
• Proficiency using Microsoft Office: Word, Excel (data analysis, sorting / filtering, pivot tables), PowerPoint (prepare formal presentations and training), Visio (develop workflow processes)
• Experience with public speaking and presenting to large audiences, including Executives and Medical Directors
• Experience interpreting provider contractual agreements
• If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained

Preferred Qualifications:

• Undergraduate degree or Masters
• Experience working with federal contracts
• 1 or more of the following certifications: CPC, CPCO, AHFI, HCAFA, CFE
• CES (Claims Editing System) SME, or SME in another clinical claims editing system
• Experience with product and vendor implementations

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 Residents Only: The salary range for Colorado residents is $94,500 to $171,700. 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: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer 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.

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

Job Keywords: payment integrity, pillars, Fraud, Waste, & Abuse (FWA), Special Investigations Unit (SIU), Telecommute, Remote, Work from Home

Keywords: UnitedHealth Group Inc., Minnetonka , Associate Director Payment Integrity - Telecommute, Other , Minnetonka, Minnesota