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Assoc. Director Business Analysis (Healthcare Payment Integrity) - Telecommute

UnitedHealth Group

Franklin, TN
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Job Details

737848 Assoc Director Business Analysis Healthcare Payment Integrity Telecommute

Assoc. Director Business Analysis (Healthcare Payment Integrity) - Telecommute (737848)

Position Description

This role will be responsible for all of the OptumCare payers (13 plans) to be implemented for Data Mining. 


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


Primary Responsibilities:

  • This role is for a Healthcare Payment Integrity (PI) expert / Solution Architect dedicated to OptumCare and accountable for execution of the following areas:

    • Data mining

    • Credit balance

    • Fraud, Waste, Abuse (FWA)

    • Subrogation & Workmen’s Comp

    • Medical Bill Audit

    • Coordination of Benefits

    • Understanding & Execution of multiple PI projects

  • New market assessment, implementation oversight of client assessment from a PI Gap Assessment

  • Assess current and future OptumCare data flows in order to identify opportunities to leverage eODS and the data lake in order to expand services to multiple CDOs

  • Develop operational best practices regarding Special Status Reconciliation

  • This role’s metrics are associated with 2018 targets for the OptumCare Payment Integrity (PI) solution which will go live next year. This role will be expected to hit the following metrics in 2018:

    • Successful and timely implementations of each Optum Care plan

    • Exceeding Optum Care data mining savings targets

    • Document best practices (WellMed) leveraging provider relationship and proactive CMS verification

    • Address timely data for external payers (TRR, MMR)

    • Extend AZ/UT Hospice solutions across all CDOs with UHC membership (part of standardize processes for Hospice)

    • This initially and individual contributor role with the prospect of eventually managing a team

    • Travel - 25% (various travel cycles)

Required Qualifications:

  • 5+ years of Payment Integrity experience in Healthcare. Expert level of knowledge of PI, solution architect dedicated to OptumCare and accountable for execution

  • Intermediate to expert level of proficiency in 2 or more of the following areas:

    • Data mining

    • Credit balance

    • Fraud, Waste, Abuse (FWA)

    • Subrogation & Workmen’s Comp

    • Medical Bill Audit

    • Coordination of Benefits

  • Expert knowledge of Medicare and Medicare Advantage


Preferred Qualifications:

  • Undergraduate degree or equivalent experience

  • High degree of interpersonal and relationship building skills to engage clients

  • Strong consulting and influencing skills; proven results as a performance consultant; ability to identify root causes, and determine solutions

  • Ability to manage competing priorities, make decisions, and effectively execute across a large, global fast-paced organization

  • Demonstrated ability to gather and analyze information from multiple sources and use to form a cohesive and comprehensive recommendation or problem solution


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)


*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: Healthcare Payment Integrity (PI), Data mining, Credit balance, Fraud, Waste, Abuse, (FWA), Subrogation, Workmen’s Comp, Medical Bill Audit, Coordination of Benefits, telecommute, telecommuter, telecommuting, remote, travel, work from home

Job Details

  • Contest Number737848
  • Job TitleAssoc. Director Business Analysis (Healthcare Payment Integrity) - Telecommute
  • Job FamilyBusiness Operations
  • Business SegmentOptum Operations

Job Location Information

  • Franklin, TN
    United States
    North America

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelDirector
  • ShiftDay Job
  • TravelNo
  • Telecommuter PositionYes
  • Overtime StatusExempt

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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