Senior Payment Policy Research Consultant

UnitedHealth Group • Eden Prairie, MN

309d • $89,800 - $176,700 • Remote

About The Position

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. As a Policy Research Consultant, you will be responsible for the identification, development, and presentation of new policy-related 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 work remotely from anywhere within the U.S. as you take on some tough challenges.

Requirements

• CPC (Certified Professional Coder) certification or industry equivalent
• 5+ years of experience billing, coding, and/or auditing healthcare claims
• 5+ years of experience researching Medicaid and other state regulatory guidelines
• 5+ years of experience researching payment integrity industry guidelines such as CMS, AMA/ CPT, etc.
• Experience presenting, collaborating, and consulting with a variety of stakeholders/clients across functional areas
• Reimbursement policy development experience
• Proficiency with MS Outlook (including ability to create and modify meeting invitations)
• Proficiency with MS Excel (including ability to create spreadsheets, manipulate data, and create pivot tables)
• Proficiency with MS PowerPoint (ability to populate templates for professional looking client presentations)

Nice To Haves

• Facility reimbursement experience (includes coding certification in facility)
• Experience working in a matrix and highly adaptive environment handling tight deadlines
• Experience in healthcare industry (Medicare, Medicaid, Commercial) with significant exposure to Payment Integrity
• Experience managing multiple concurrent projects and meeting tight delivery timelines
• Familiarity and experience with SQL or other data analytic tools
• Proven highly collaborative and consultative style
• Proven ability to establish credibility quickly with all levels of management
• Proven to be an innovative thinker that works well in an ambiguous, growth environment
• Proven solid project management approach with excellent critical thinking and problem-solving skills
• Proven to be self-motivated and can produce results with minimal supervision

Responsibilities

• Research and identify industry guideline support for new medical cost savings initiatives across Medicare, Medicaid, and Commercial lines of business
• Partner with data team and conduct claims data analysis to determine viability of new reimbursement policy opportunities
• Collaborate with internal and external cross-functional teams to assess risk and gain alignment on new / enhanced policy direction and development
• Thoroughly and accurately evaluate and package reimbursement policy affordability concepts for clients to ensure acceleration, prioritization, quality, and successful approval and implementation
• Contribute policy thought leadership and research on Payment Integrity strategic initiatives and programs as needed
• Mitigate issues / risks on policy concepts and escalate with leadership as appropriate

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree