UnitedHealth Group Director, Payment Integrity, OptumServe - Eden Prairie, MN or Telecommute in Eden Prairie, Minnesota

There’s never been a time that was more right for people who want to lead. Health care is changing and evolving at a pace that few could have predicted. Technology, ideas, and bold vision are taking companies like UnitedHealth Group to new levels of performance. This is the time and the opportunity that can bring your impact to a whole new level. We’re an innovation leader in creating new provider networks that enable higher levels of system performance and effective levels of diligence and accuracy in billing, reimbursements, and audits. As a member of our team, you’ll work with analysts and consultants who identify and correct errors of individual network members and systems. As part of the team, you’ll discover the resources, backing, and opportunities that you’d expect from a Fortune 5 leader.

Primary Responsibilities:

  • Perform comprehensive research and identify billing abnormalities, questionable billing practices, and/or irregularities

  • Conduct research and analyses of claims data to determine details of fraudulent or abusive billing activity

  • Direct internal and on-site audits of provider records, clinical records, and itemized bills so as to ensure appropriateness of billing practices and correct errors or overpayments

  • Develop and execute strategies that span a large business unit or multiple markets / sites

  • Resolve business problems that affect multiple functions or disciplines

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

Get ready for some significant challenges. This is a fast paced, highly focused business operation that will require you to effectively direct metrics, analyses, and planning with large financial impact. You’ll need to be adept at juggling priorities in an ever-shifting environment.

Required Qualifications:

  • 8+ years of experience in the health care industry, in auditing, claims processing, or payment integrity

  • 5+ years of experience conducting or managing comprehensive research to identify billing abnormalities, questionable billing practices, irregularities, and fraudulent or abusive billing activity

  • Proficiency in performing financial analysis including statistical calculation and interpretation

  • Experience with Fraud, Waste, & Abuse programs

  • Familiarity with STARS system

Preferred Qualifications:

  • Undergraduate degree

  • Experience working with federal contracts

Building efficiency and trust into Provider Network operations is an incredible way to help improve the lives of millions. Be a part of it. Learn more about how you can start doing your life's best work.(sm)

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

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.

Diversity creates a healthier atmosphere: OptumCare and its affiliated medical practices are Equal Employment Opportunity/Affirmative Action employers 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.

OptumCare and its affiliated medical practices is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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