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Manager, Payment Integrity and Data Mining Operations - Franklin, TN

UnitedHealth Group

Franklin, TN
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Job Details

735438 Manager Payment Integrity and Data Mining Operations Franklin TN

Manager, Payment Integrity and Data Mining Operations - Franklin, TN (735438)

Position Description

You know this to be true. The changes impacting health care are adding new complexity and new challenges by the day. Today, new models of care and new networks of providers are emerging to better serve patients and communities. UnitedHealth Group is an innovation leader in creating new levels of system performance and effective levels of diligence and accuracy in billing, reimbursements and audits. That’s where you come in. As a leader on our network management team, you’ll oversee teams of analysts and consultants who identify and correct errors of individual network members and systems. As part of the team, you’ll discover the resources, backing and opportunities that you’d expect from a Fortune 6 leader.


Primary Responsibilities:

  • Oversee individuals performing comprehensive research and identify billing abnormalities, questionable billing practices and / or irregularities
  • Manage research and analyses of claims data to determine details of fraudulent or abusive billing activity
  • Direct internal and on - site audits of provider records, clinical records and itemized bills so as to ensure appropriateness of billing practices and correct errors or overpayments
  • Set team direction, resolve problems and provide guidance to members of own team
  • Adapt departmental plans and priorities to address business and operational challenges
  • Influence or provide input to forecasting and planning activities

Get ready for some significant challenge. This is a fast paced, highly focused business environment that requires you to motivate and manage a complex team of data mining auditors and meet required revenue targets.


Required Qualifications:

  • Undergraduate degree or equivalent experience
  • 5+ years experience in the health care industry, preferably in an auditing role
  • 3+ years conducting or managing comprehensive research to identify billing abnormalities, questionable billing practices, irregularities and fraudulent or abusive billing activity
  • Proficiency in performing financial analysis including statistical calculation and interpretation
  • Intermediate proficiency with MS Office

Preferred Qualifications:

  • Supervisory experience
  • Experience with claims processing systems such as UNET, COSMOS, Facets, Diamond, etc. and contracting applications (diCarta, Contract Manager, Purchasing Calendar and CCI Submission Databases)

Building efficiency and trust into Provider Network operations is an incredible way to help improve the lives of millions.  Be a part of it. Learn more about how you can start doing your life’s best work.(sm)



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: health care, managed care, audit, recovery, payment, payment integrity, research, claims, claims processing, billing, fraud, fraudulent, abusive billing activity, FWAE, medical coding, supervisor, manager, Franklin, Nashville, TN, Tennessee




Job Details

  • Contest Number735438
  • Job TitleManager, Payment Integrity and Data Mining Operations - Franklin, TN
  • Job FamilyNetwork Management
  • Business SegmentOptum Operations

Job Location Information

  • Franklin, TN
    United States
    North America
  • Other LocationsNashville, TN

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelManager
  • ShiftDay Job
  • TravelNo
  • Telecommuter PositionNo
  • 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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