Senior Director, Optum Health Payment Integrity - Remote

UnitedHealth Group•Eden Prairie, MN

2d•$159,300 - $273,200•Remote

About The Position

The Senior Director Optum Health Payment Integrity will responsible for managing Payment Integrity (PI) operations for Optum Health including the oversight of vendor delivered programs. This includes oversight of vendor implementations, vendor management and ongoing operational delivery functions for all programs. The senior director will lead teams accountable for the execution of ACE, CES, Itemized Bill Review, Professional & Facility audit, outpatient audit, data mining, credit balance, subrogation, fraud and abuse, and coordination of benefits. They will be responsible for 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. Tactical functions include claims processing, capacity analysis planning and reporting, data integrity, CMS and compliance adherence, vendor management, inventory management, operations management, and forecasting. The senior director of Optum Health PI will need to work with numerous matrix partners to manage deliverables, provide policy expertise, communicate change, and manage escalations. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.

Requirements

10+ years of Payment Integrity and/or claims operations experience
7+ years of healthcare operations; working within a health plan and/or managed care business operations
7+ years of progressive leadership including leading operations and/or business processes
Experience across all Payment Integrity value streams; capable of aligning to and driving Optum Health PI strategy
Medicare experience
Vendor management experience
Experience coordinating and navigating complex matrixed organizations
Experience managing a comprehensive portfolio of programs
Proven solid consulting and/or influencing skills; proven results as a performance consultant
Proven ability to manage competing priorities, make decisions, and effectively execute across a large, complex fast faced organization

Nice To Haves

Certified Coder in ICD 10 and ICD 9 or RN/LPN
Lean Six Sigma (Green belt/Kaizen)
Experience in forecasting and budget management
Experience developing and managing operational metrics
All LOB (Medicaid, Medicare, Commercial) expertise
Proven degree of interpersonal and relationship building skills to engage clients
Demonstrated ability to gather and analyze information from multiple sources and use to form a cohesive and comprehensive recommendation or problem solution

Responsibilities

Accountable for execution of all Payment Integrity suite of products; pre and post pay operations. Professional and facility
Provide leadership over delivery and vendor teams to ensure delivery on gross and incremental savings targets
End to end process ownership for Optum Health PI
Identify, implement, and report opportunities to improve processes, procedures, systems
Develop solid partnership with matrixed partners and stakeholders
Provide market-facing support to support escalations, communicate change, and deliver budgeted savings
Collaborate with a wide variety of matrix partners including but not limited to; healthcare economics, network management, claims operations, compliance, and regional and national medical directors, finance, internal and external vendors, UHC, OGA
Lead program management for Optum Health PI services. Coordinating with vendors to improve performance, expand scope of services, reduce abrasion, and increase savings
Manage deliverables to achieve set targets
Align staffing volumes/needs with savings forecasts and volumes
Deliver expert vendor management practices to ensure that operational processes are standardized across multiple vendors and internal programs
Drive favorable program outcomes across 15 integrated markets and 2 non-integrated
Document and communicate outcomes of claims investigations/overpayment/prepayment reviews to applicable stakeholders
Manage multiple line of business with varying regulations and compliance rules
Effectively plan staff responsibilities and manage vendor deliverables to meet department goals
Lead and collaborate with claim operations team to identify ‘shift left’ opportunities to drive reductions in recovery adjustments
Manage domestic and OGA work inventories
Demonstrate understanding of applicable federal, state, and local compliance regulations (e.g., DOI, DOL, Healthcare Reform/PPACA, CMS) and ensure adherence
Ensure all operational metrics are met
Closely monitor provider abrasion and manage within controls; driving quality improvement, true positive increases, and appeal rate reductions
Deliver business requirements for savings and operational metrics dashboard reports
Understanding of claims processing end-to-end
Lead implementation management for any program expansions, market expansions
Develop cost benefit analysis for proposed program expansions