Associate Director - Payment Integrity Operations - Remote

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together .

The Associate Director of OptumCare Payment Integrity operations will serve as the operational leader for Datamining, Credit Balance, and Subrogation payment integrity programs. Including vendor implementations, vendor management and ongoing operational delivery functions. The AD will lead a team that includes both operational resources and business analysts. They will act as the lead program owner of their suite of products; driving multi-year growth strategies, collaborating with business partners and markets, creating staffing and financial forecasting, monitoring KPI's, enabling automation, as well as ongoing opportunity identification and benefit analysis. Functions include claims system utilization, capacity analysis planning and reporting, data integrity, CMS and compliance adherence, vendor management, rule validation and approval, medical expense reduction, and forecasting. The AD will work with matrix partners to manage deliverables. They will drive favorable outcomes by partnering with matrix partners to provide policy expertise which drives savings and revenue. AD will need to achieve gross and incremental savings targets through effective capacity planning, inventory management, vendor management, growth strategy, automation and operational discipline.

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

Primary Responsibilities:

• Provide leadership over Datamining, Credit Balance, and Subrogration Payment Integrity teams to ensure delivery on gross and incremental savings targets

• Provide market-facing support

• Lead program management for datamining, credit balance and subrogation services. Coordinating with vendors to improve performance, expand scope of services, and reduce abrasion

• Lead the savings forecasting for data mining, credit balance and subrogation programs

• Provide vendor management and partnership with internal and external partners to ensure that the appropriate operational processes are in place and proper follow up/communications are occurring for successful operational delivery

• Drive favorable algorithm outcomes by partnering with matrix partners to provide policy expertise which will drive market savings and medical expense reduction

• Effectively plan staff responsibilities and manage vendor deliverables to meet department goals

• Lead and collaborate with claim operations team to drive improved automation on recovery adjustments

• Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance

• Ensure all operational metrics are met

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:

• 7+ years of experience working within a health plan and/or managed care business operations

• 5+ years in leadership role with experience in management of front line staff

• 5+ years of experience in forecasting and budget management

• 5+ years developing and managing operational metrics

• 3+ years of postpay payment integrity experience - specifically in the datamining, credit balance, subrogation or coordination of benefits areas

• 2+ years vendor management experience

• Experience coordinating and navigating complex matrixed organizations

Preferred Qualifications:

• Certified Coder in ICD 10 and ICD 9 or RN/LPN

• Lean Six Sigma (Green belt/Kaizen)

• Experience in fraud detection, analytic methodologies, payment policies and provider contracts

• Claims processing expertise

• OptumCare/Optum Health expertise

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, or Washington, Washington, D.C. Residents Only: The salary range for this role is $104,700 to $190,400 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

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.