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Post Payment Integrity Pillar Lead CA - Telecommute

Company: UnitedHealth Group
Location: Phoenix
Posted on: November 23, 2021

Job Description:

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)OptumCare is a network of health care providers in local markets whose mission is to help providers deliver the most effective and compassionate care to each patient they serve. OptumCare's primary focus is on doing the right things for patients, physicians, and the community. It uses an innovative service model focused on measuring what matters and increasing efficiency and performance while providing the highest level of customer service. This model allows OptumCare to make a difference each day by delivering highly personal, customized care management to its patients.The Post Payment Integrity Pillar Lead CA will play a critical role in coordination and completion of growth projects across various Optum Care Service Operation teams. With a core focus on Post Payment Integrity activities in California, you'll be engaged in a complex business model that prioritizes customer experience and innovative solutions through technology and service standards. As part of a team that provides solutions and value across a variety of Optum Care teams, it is critical that this role brings curiosity, growth mindset, and personal accountability to the work each day, showing up as flexible and productive in the face of change or obstacles. The successful candidate can build trust and rapport with individuals as they work and is passionate about driving plans into action.You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.Primary Responsibilities:

  • Collect and analyze complex data to identify and prioritize payment integrity savings opportunities within our California markets
  • Become proficient in the local California regulatory, compliance and network contracting areas in order to successfully identify and deploy payment integrity programs
  • Work across Optum Care entities to develop and implement effective/strategic business solutions through research and analysis of data and business processes
  • Support short- and long-term operational/strategic business activities through analysis
  • Establish matrixed relationships with internal stakeholders (including claims operations, network management, medical management) to define, align, and deliver payment integrity initiatives in support of assigned markets
  • Establish governance meeting cadence with California market CDOs
  • Develop California market specific reporting for all pillars
  • Issue resolution, as needed/required
  • Work across all SIUs to refer potential FWA issuesYou'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.Required Qualifications:
    • Bachelor's Degree or equivalent work experience
    • 5+ years of experience with Payment Integrity
    • 5+ years of experience in the health care industry
    • 2+ years of experience working within government lines of business
    • 2+ years of experience conducting or managing comprehensive research to identify billing abnormalities, questionable billing practices, irregularities, and fraudulent or abusive billing activity
    • 2+ years of experience performing financial analysis/audit including statistical calculation and interpretation
    • Proficiency in various claims payment methodologies; to include capitation, fee-for-service, DRG, percent-of-charge, and OPPS
    • Proficiency using Microsoft Office: Word, Excel (data analysis, sorting/filtering, pivot tables), PowerPoint (prepare formal presentations and training), Visio (develop workflow processes)
    • Experience interpreting provider contractual agreements
    • Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliancePreferred Qualifications:
      • One or more of the following certifications: CPC, CPCO, AHFI, HCAFA, CFE
      • 4+ years of experience using claims platforms such as Facets, Xcelys, IDX, IKA, Epic
      • Experience with post pay payment integrity products, management, and oversight
      • Experience in auditing, claims processing, payment integrity, claims configuration
      • Experience with California health plan operations
      • Experience working with federal contracts
      • Experience with product and vendor implementationsTo protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.Careers at OptumCare. We're on a mission to change the face of health care. As the largest health and wellness business in the US, we help 58 million people navigate the health care system, finance their health care needs and achieve their health and well-being goals. Fortunately, we have a team of the best and brightest minds on the planet to make it happen. Together we're creating the most innovative ideas and comprehensive strategies to help heal the health care system and create a brighter future for us all. Join us and learn why there is no better place to do your life's best work.(sm) OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare's support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $79,700 to $142,600. The salary range for Connecticut/Nevada residents is $87,900 to $156,900. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.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: Post Payment Integrity Pillar Lead CA, California, Optum, OptumCare, UHG, UnitedHealth Group, Telecommute, Telecommuter, Telecommuting, Work at Home, Work from Home, Remote

Keywords: UnitedHealth Group, Phoenix , Post Payment Integrity Pillar Lead CA - Telecommute, Accounting, Auditing , Phoenix, Arizona

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