Associate Director, Payment Integrity
4 weeks ago
Optum is a global organisation 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.
About the Role:
In healthcare, evolution doesn't just happen. It takes innovation, imagination, and a passion for solving problems in new and better ways. And innovation is taking place at a lightning-fast pace every day at Optum.
As the fastest growing part of the UnitedHealth Group family of businesses, we're expanding our team in Ireland and creating excellent opportunities for those who want greater purpose and more impact in their work. We'll provide the investment, support, and resources to advance your career. You'll provide the talent, ambition, and drive.
As an Associate Director, Payment Integrity you will research and investigate key business problems through quantitative analyses of utilization and healthcare costs data. Provides management with statistical findings and conclusions. You'll have the opportunity to Identifiy potential areas for medical cost improvements and alternative pricing strategies. Provides data in support of actuarial, financial and utilization analyses.
Primary Responsibilities of the Associate Director - Payment Integrity:
• Identify, create, and develop a Medical Rx portfolio of cost savings initiatives that drive specific and measurable results for clients while providing timely and meaningful client updates
• Perform and participate in iterative analytical, experimental, investigative and other fact-finding work in support of concept development
• Establish strong 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
• Recommend changes to current product development procedures based on market research and new trends
• Industry thought leader and subject matter expert for Professional and outpatient facility Medical drug claims, related trends, pricing, and cost management initiatives
• Lead concepts/projects from conceptualization to completion
You will be rewarded and recognised 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 providing development for other roles you may be interested in.
Required Qualifications of the Associate Director, Payment Integrity:
• Strong proven experience auditing, billing, and/or coding claims
• Experience assessing and monitoring Specialty drug trend in the Medical benefit
• Experience in the health care industry (Medicare, Medicaid, Commercial) with deep exposure to Payment Integrity
• Work experience in highly collaborative and consultative roles, with ability to establish credibility quickly with all levels of management across multiple functional areas
• Experience with interpreting data sets
• Experience presenting proposals to stakeholders and internal customers
• Project Management experience
• Working knowledge of CMS rules and regulations and billing codes and related services
Preferred Qualifications of the Associate Director, Payment Integrity:
• Undergraduate Degree strongly preferred
• Advanced degree in health care or medical field
• Coding certification through AAPC or AHIMA
• Experience in claims adjudication or revenue cycle management
• Experience working in a matrixed and highly adaptive environment handling tight deadlines
• Proficiency with SQL, SAS and/or other statistical programs
• Self-managed, self-starter with the ability to support multiple concurrent projects and meet tight delivery timelines
• Solid project management approach with excellent critical thinking and problem-solving skills
• Exceptional presentation, communication, and negotiation skills
• Solid computer skills: Excel, Visio, PowerPoint, Tableau
Please note you must currently be eligible to work and remain indefinitely without any restrictions in the country to which you are making an application. Proof will be required to support your application.
All telecommuters will be required to adhere to the UnitedHealth Group's Telecommuter Policy.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalised groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
Diversity creates a healthier atmosphere: Optum is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to gender, civil status, family status, sexual orientation, disability, religion, age, race, and membership of the Traveller community, or any other characteristic protected by law. Optum is a drug-free workplace. © 2024 Optum Services (Ireland) Limited. All rights reserved.
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