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Payment Integrity Ideation Consultant - Eden Prairie, MN (Preferred) or Telecommute

UnitedHealth Group

Eden Prairie, MN
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Job Details

747861 Payment Integrity Ideation Consultant Eden Prairie MN Preferred or Telecommute

Payment Integrity Ideation Consultant - Eden Prairie, MN (Preferred) or Telecommute (747861)

Position Description

As an Ideation Consultant, you will be responsible for the identification, development, and presentation of new medical cost savings opportunities on behalf of our clients. This position will assess new opportunities based on data insights leveraging tools, policies, industry trends, and by soliciting input from a broad network of experts across Optum. This highly trained industry expert will work with internal and external business constituents to determine opportunities for growth within our core payment integrity businesses and be responsible for savings delivery through deployment.

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

Primary Responsibilities:

  • Support existing and develop new medical record review and administrative hold concepts / edits that drive specific and measurable results
  • Providing timely and meaningful client updates
  • Participate in analytical, experimental, investigative and other fact-finding work in support of concept development
  • Establish strong relationships with internal and external stakeholders to define, align, and deliver payment integrity initiatives in support of assigned clients
  • Influence senior leadership to adopt new ideas, approaches, and/or products
  • Recommend changes to current product development procedures based on market research and new trends
  • Industry thought leader and practice SME

Required Qualifications:

  • BA / BS degree or equivalent experience
  • 3 or more years of experience in the health care industry (Medicare, Medicaid, Commercial) with deep exposure to Payment Integrity
  • 3 or more years of experience billing, coding, and auditing claims
  • Strong computer skills: Access, Excel, Visio, PowerPoint & Basic level proficiency with SQL
  • Working knowledge of CMS rules and regulations
  • Knowledge of correct coding guidelines (CPT, HCPCS, DRG and ICD 9/10)
  • Knowledge of reimbursement methodologies (FFS / professional, APC, DRG, etc.)

Preferred Qualifications:

  • Advanced degree in health care or medical field
  • Fraud Waste and Abuse experience
  • 2 or more years of experience working in a matrix and highly adaptive environment handling tight deadlines
  • Coding certification through AAPC or AHIMA
  • Experience reviewing and interpreting medical claims healthcare data from a medical coding and reimbursement perspective
  • Knowledge of statistical methods used in the evaluation of healthcare claims data
Soft Skills:
  • Highly collaborative and consultative style with ability to establish credibility quickly with all levels of management across multiple functional areas
  • Self-managed, self-starter with the ability to support multiple concurrent projects and meet tight delivery timelines
  • Strong project management approach with excellent critical thinking and problem solving skills
  • Exceptional presentation, communication and negotiation skills

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:  Payment Integrity Ideation Consultant, Eden Prairie, MN, Minnesota, Telecommute, Remote, Work from Home

Job Details

  • Contest Number747861
  • Job TitlePayment Integrity Ideation Consultant - Eden Prairie, MN (Preferred) or Telecommute
  • Job FamilyHealthcare Economics
  • Business SegmentOptumInsight

Job Location Information

  • Eden Prairie, MN
    United States
    North America

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelIndividual Contributor
  • 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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