Payment Integrity Ideation Associate Director – Home & Community RN – Remote - Remote Eligible

Requisition Number: 2231933
Job Category: Healthcare Economics
Primary Location: Minnetonka, MN, US
(Remote considered)

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 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.

The Payment Integrity Ideation Associate Director is responsible for the research, sizing, analysis, and delivery of payment integrity content and innovation programs in the PIDI space. This role works with UHC business, Business Analysts, UHC network and policy, and the Core Analytics and Data Science technical teams. The Ideation Lead researches and investigates key business problems through quantitative analyses of utilization and healthcare costs data, provides management with statistical findings and conclusions, presents new affordability concepts in client governance and approval processes, engages production support for successful concept deployment.   The specific role here will be focused on identifying and developing concepts for UHC affordability specific to Home and Community spend.

The successful candidate will be a payment integrity or analytics professional with experience in home and community, healthcare coding, claims, payment integrity operations, analyzing data, working in cross functional teams, building relationships, and communicating information related to Payment Integrity. Those best suited for this position have solid research, execution, payment integrity business, analytic, and relationship skills. The role requires the ability to discuss and manage deliverables at a rapid pace in a highly matrixed environment. This position requires a self-starter who is passionate about delivering maximum value from Optum’s Payment Integrity Solutions through collaboration with matrix partners and clients.

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

Primary Responsibilities:

• Analyze data containing health claims to understand drivers of spend and trends for UHC Home and Community
• Leverage data to identify errors or issues, and work across the Affordability organization to design and propose content and technical solutions to address the issues
• Identify, create, and develop a portfolio of cost savings initiatives that drive specific and measurable results for Home and Community spend while providing timely and meaningful updates
• Establish solid matrixed relationships with internal 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
• Industry thought leader and subject matter expert for medical claims, related trends, pricing, and cost management initiatives
• Lead concepts/projects from conceptualization to completion
• Research industry trends and emerging themes associated with Home and Community affordability, resents thought leadership to product and client stakeholders

You’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:

• Registered Nurse (RN) with a current, active, and unrestricted RN License in the US
• 4+ years of experience auditing, billing, and/or coding claims within a Payment Integrity domain
• 3+ years of experience working in a matrixed and high change environment handling tight deadlines
• 2+ years of experience performing research and analysis of claims data and applying results to identify trends/patterns
• 2+ years of experience working as an RN in a Home Health role/setting
• Experience with health care and analytics with ability to translate complex analytic results into meaningful insight for maximum customer impact and influence
• Experience developing and presenting PowerPoint presentations to Stakeholders and Sr. Leadership
• Ability to maintains working knowledge of CMS rules and regulations and billing codes and related services (CPT, HCPCS, ICD coding experience) with an emphasis on Home and Community
• Proven ability to establish credibility and build relationships at all levels (persuasive speaking and storytelling with data)

Preferred Qualifications:

• Coding certification through AAPC or AHIMA
• Experience with CSP and/or COSMOS platform
• Proven solid computer skills: Excel (Pivot Tables, Advanced Formulas, macros, etc..), Visio, PowerPoint, Tableau
• Ability to be self-managed, self-starter, and to work in rapidly changing environment
• Proven excellent negotiation skills
• Proven excellent verbal and written communication skills
• Ability to be organized, disciplined and capable of ensuring a large volume of work is moving to schedule
• Proven solid problem-solving skills, initiative, and creativity in anticipating and solving issues and implementing next steps

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, Washington, Washington, D.C. Residents Only: The salary range for this role is $104,700 to $190,400 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.