Supervisor, Revenue Integrity & Analytics - Remote

UnitedHealth Group•Las Vegas, NV

9d•$29 - $52•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 resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. The Revenue Integrity Supervisor is responsible for overseeing West revenue integrity processes to drive appropriate reimbursement, pricing accuracy, transparency and expertise for charge capture. 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 Las Vegas , you will be required to work in the office a minimum of 2 times a month or PST working hours 8 am to 5pm Monday Thru Friday

Requirements

2+ years of experience in Healthcare Revenue Cycle Operations including revenue integrity, reimbursement methodologies, denials, and process improvement
2+ years of experience in advanced analytics, delivering actionable insights from data, databases, and big data analytics environments
Working knowledge of medical coding (ICD, CPT, HCPCS)
Exposure to healthcare data from multiple sources: Payor claims processing, EDI, EHR
Experience in working with multi-disciplinary teams and varying levels of leadership
Knowledge of third-party payer requirements including federal, state, and private health care plans and authorization process
Intermediate proficiency with Microsoft products such as Excel, PowerPoint, Word, Project
Solid problem-solving, critical thinking, and analytical skills
Demonstrated comprehension of complex clinical and revenue integrated systems and processes
Solid & efficient communication and customer service skills

Nice To Haves

Ability to take direction from senior leadership but also be able to work independently with follow-through and handle multiple tasks simultaneously
Solid verbal skills and ability to communicate abstract concepts in a simple format
Solid organizational skills: ability to prioritize work; detail oriented
Ability to educate and train all levels of professional staff
Ability to be proactive, self-directing, and take initiative
Ability to work efficiently under pressure

Responsibilities

Supervises daily revenue integrity operations, including payer payment and pricing applications, charge control processes, system updates as needed
Maintains the chargemaster and fee schedules for West Region; completes annual and quarterly updates; documents approved changes; and coordinates annual CDM CPT/HCPCS updates
Monitors charge-capture controls, including revenue reconciliation, change management, and supports departmental accountability for complete and accurate charges
Reviews, works, and resolves Epic charge-related work queues and billing edits accurately and within established turnaround times
Partners with Coding and clinical departments to identify and correct charge, billing, documentation, and coding errors in accordance with ICD, CPT, HCPCS, payer, and National Correct Coding Initiative requirements
Serves as the primary service-line resource for charge-related questions, charge-code use, payer coverage, and payment requirements
Identifies opportunities to optimize practice management and revenue cycle technology, integrate business intelligence tools, automate manual processes, and standardize reporting across the West
Analyzes, validates, and distributes KPI dashboards, quality-control reports, monthly operational reports, and ad hoc analyses for Revenue Cycle, Finance, Clinical Operations, and other stakeholders
Analyzes charges, payments, denials, and reimbursement trends to identify revenue gaps, short payments, noncompliance, and opportunities to accelerate collections and prevent revenue loss
Conducts routine claim and chargemaster reviews, coordinates complex denials and payer audits, and escalates or troubleshoots claim and reimbursement issues with payers
Monitors Medicare, Medicaid, and commercial payer guidance and medical policies; evaluates operational and financial impacts; and implement approved compliance changes with Revenue Integrity and operational leaders
Meets with operational leaders to review revenue cycle metrics, identify trends and issues, and develop interim and long-term improvement plans
Supports payer contract configuration in practice management systems and monitors payments against contractual terms to identify reimbursement variances
Participates in revenue cycle improvement initiatives and completes other duties or projects that support organizational goals