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Director of Operations - Medicare & EDI - Horsham, PA, Wauwatosa, WI or Telecommute

UnitedHealth Group

Horsham, PA
Job Code:
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Job Details

Director of Operations - Medicare & EDI - Horsham, PA, Wauwatosa, WI or Telecommute(Job Number:710208)

If you want to achieve more in your mission of health care, you have to be really smart about the business of health care. Challenge yourself, your peers and our industry by shaping what health care looks like and doing your life's best work.(sm)

The role of this position is twofold:  First, ensure the Business is prepared to effectively and efficiently respond to changes mandated by the Center for Medicare and Medicaid Services (CMS) that may impact the Medicare Fee for Service (FFS) program and/or Medigap.   Second, drive the development and execution of a comprehensive EDI strategy to guide our transactional capabilities and oversee compliance with all regulatory standards.

Primary Responsibilities:

Drive overall strategy and execution of objectives and experience related to EDI standards, CMS, Medicare FFS, Medigap and other government health programs for Medicare beneficiaries include, including but not limited to: 

  • Providing guidance to areas within the Business regarding upcoming changes and operational impacts of proposed or approved regulatory changes related to electronic business
  • Evaluating communications from CMS to ensure the Business is aware of and prepared for proposed and approved changes in payment, regulation, transmission of data etc.
  • Planning, organizing and coordinating projects and/or special studies related to the Medigap program to recommend changes that maximize operational efficiency
  • Providing technical direction to team members and/or other areas of the Business on Medicare rules and policies and EDI requirements
  • Engaging with industry expects, internally and externally, to drive the development of future technology
  • Evaluating evolving electronic data standards to identify areas of improvement and possible program expansions; coordinate projects and studies and make recommendations for improvement
  • Partnering with IT, Finance, Actuarial  Compliance and Operations to develop, implement and maintain a comprehensive EDI strategy focused on efficiency, needed capabilities and current standards
  • Managing performance, quality, efficiency, and effectiveness of external Operational Vendors
  • Developing, implementing and leading a new Rules Configuration team to support ongoing core system modernization efforts

Job General Operations Management
Primary Location US-PA-Horsham
Other Location US-WI-Wauwatosa
Organization M&R Insurance Solutions
Schedule Full-time
Number of Openings 1
Apply on the Company Site

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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