Director Commercial Growth, DRG & Bundled Payments - | , |

Payment Integrity Expert

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.

Within Optum's Payer Market we are seeking a strong Payment Integrity expert to shape and execute a strategy that drives savings growth with external Commercial Clients and select internal clients on our DRG and associated bundled payment businesses. In this role, the expectation is to provide leadership, management and vision in creating plans and offerings that match our capabilities with client needs to drive medical cost savings growth.

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 Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.

Primary Responsibilities:

• Create and drive integrated growth strategy for DRG and bundled payments at our top 15 clients and beyond. This individual will define where we are going to play (and importantly where we are not going to play) and how we are going to win (points of advantage, points of parity)
• Accelerate DRG/Bundled payments savings/revenue growth at Commercial/External clients
• Identify portfolio gaps at top clients and create and implement plans to close
• Support Payer Market and Sales team in pitching new concepts to clients
• Apply systems-thinking to identify root causes of claim leakage and inefficiencies
• Collaborate with product owners, analytics engineers, technology teams, and other SMEs to develop and deploy innovative, scalable solutions
• Oversee the end-to-end lifecycle of concept development from ideation and research to sizing, validation, and deployment
• Translate concepts into operational execution by managing deployment timelines, and operational readiness

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:

• 7+ years of Payment Integrity Expertise, specifically including knowledge of pre-pay, post-pay methodologies, familiarity with core PI processes and technologies
• 3+ years of inpatient coding/auditing/claims lifecycle experience
• Direct experience with claims workflow technology/platforms (e.g. FACETS, HRP, etc.)
• Deep understanding of the U.S. healthcare system and claim lifecycle - how claims are coded and billed
• Familiarity with emerging technologies including automation, machine learning, and AI tools to enhance ideation and solutioning
• Proven ability to apply systems-thinking and strategic vision to identify root causes of claim leakage and develop scalable, data-driven solutions
• Demonstrated ability to collaborate regularly with matrix partners

Preferred Qualifications:

• Experience and familiarity with DRG claims and audits
• Experience and familiarity with Commercial Clients and their payment integrity approaches and strategies
• Experience participating in client QBRs and other client-facing interactions
• Familiarity with a spectrum of payers including big nationals, blues and smaller regionals

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $134,600 to $230,800 annually based on full-time employment. We comply with all minimum wage laws as applicable.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.