Associate Director – Payment Integrity Operations
2306625
Optum (a part of UnitedHealth Group)
Business Operations
Primary: Eden Prairie, Minnesota, US
Remote: Yes – Open to telecommuters within the U.S.
Full-Time, Regular
Day Job
Exempt
Yes
Remote workers must comply with UnitedHealth Group’s Telecommuter Policy.
The Associate Director – Payment Integrity Operations will lead and manage the Correct Coding operations within OptumCare’s Payment Integrity group. This includes overseeing vendor operations, ensuring adherence to compliance standards, managing a team of business analysts and operational staff, driving coding accuracy, optimizing staffing and financial forecasting, and supporting savings and performance metrics across multiple business units.
Provide end-to-end process ownership for coding and payment integrity outcomes
Lead a team responsible for correct coding services, including internal operations and vendor delivery
Ensure all operational metrics, gross savings, and incremental savings targets are met
Implement expert vendor management practices across multiple partners
Coordinate with vendors to improve performance, reduce abrasion, and increase savings
Oversee standardization of operational processes across internal and external vendors
Partner with matrixed stakeholders: healthcare economics, claims, network management, compliance, finance, UHC, OGA, and medical directors
Communicate change and resolve escalations effectively
Support markets with budgeted savings, escalations, and program changes
Monitor KPIs and operational dashboards
Deliver business reports related to savings, staff productivity, and provider appeal metrics
Align staffing needs with savings forecasts and volumes
Develop cost-benefit analysis for program or market expansions
Drive strategy to increase automation and efficiency
Identify and implement process improvements to improve coding accuracy and reduce errors
Lead "shift-left" initiatives to reduce downstream adjustments and provider abrasion
Ensure compliance with CMS, PPACA, DOI, DOL, and other regulatory bodies
Oversee QA functions related to claims investigations, prepayment/post-payment audits
Track provider abrasion, appeals, true positive rates, and drive improvements
Certified Coder (CPC, CIC, CIMC or equivalent)
7+ years in healthcare leadership roles
7+ years experience in health plan or managed care business operations
3+ years managing front-line operational staff
3+ years collaborating with clinical staff (MDs)
3+ years of budget and forecasting experience
3+ years in developing/managing operational KPIs
3+ years in Payment Integrity (prepayment or post-payment)
2+ years client management experience
Strong experience navigating complex matrixed organizations
Lean Six Sigma (Green Belt or Kaizen certification)
Experience in provider office or practice administration
Clinical credentials (LPN, LVN, RN)
Experience in fraud detection, payment policies, analytics, and provider contracts
Salary Range: $110,200 – $188,800 per year (based on experience, education, location, certifications, etc.)
Additional Benefits:
Incentive & recognition programs
401(k) contribution
Equity stock purchase program
Comprehensive health & wellness benefits
Career development opportunities
This role will remain open for at least 2 business days or until a sufficient candidate pool has been collected. It may close earlier based on application volume.
Applicants must be legally authorized to work in the United States without sponsorship.
UnitedHealth Group is an Equal Employment Opportunity (EEO) employer. All qualified applicants will receive consideration without regard to:
Race, gender, sexual orientation, religion, age, disability, veteran status, or any other protected status.
UnitedHealth Group is also committed to:
Reducing health disparities
Environmental sustainability
Creating a diverse, inclusive workplace
UnitedHealth Group is a drug-free workplace. All candidates must pass a drug test before beginning employment.
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