As an Ideation Consultant, you will be responsible for the identification, development, and presentation of new medical cost savings opportunities on behalf of our clients. This position will assess new opportunities based on data insights leveraging tools, policies, industry trends, and by soliciting input from a broad network of experts across Optum. This highly trained industry expert will work with internal and external business constituents to determine opportunities for growth within our core payment integrity businesses and be responsible for savings delivery through deployment. You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
- Support existing, and develop new, medical record review and administrative hold concepts/edits that drive specific and measurable results
- Provide timely and meaningful client updates
- Participate in analytical, experimental, investigative, and other fact-finding work in support of concept development
- Establish strong relationships with internal and external 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 practice SME
- BA/BS degree or equivalent experience
- 3+ years of experience in the healthcare industry (Medicare, Medicaid, Commercial), with deep exposure to Payment Integrity
- 3+ years of experience billing, coding, and auditing claims
- Intermediate proficiency in Access, Excel, Visio, PowerPoint
- Basic level proficiency with SQL
- Working knowledge of CMS rules and regulations
- Knowledge of correct coding guidelines (CPT, HCPCS, DRG, and ICD 9/10)
- Knowledge of reimbursement methodologies (FFS/professional, APC, DRG, etc.)
- Advanced degree in health care or medical field
- Fraud Waste and Abuse experience
- 2+ years of experience working in a matrixed and highly adaptive environment handling tight deadlines
- Coding certification through AAPC or AHIMA
- Experience reviewing and interpreting medical claims healthcare data from a medical coding and reimbursement perspective
- Knowledge of statistical methods used in the evaluation of healthcare claims data
Highly collaborative and consultative style with ability to establish credibility quickly with all levels of management across multiple functional areas
Self-managed, self-starter with the ability to support multiple concurrent projects and meet tight delivery timelines
Strong project management approach with excellent critical thinking and problem-solving skills
Exceptional presentation, communication, and negotiation skills
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer 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.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Job keywords: payment integrity, Medicare, Medicaid, commercial, healthcare, claim adjudication, coding, CPT, DGR, SQL, excel, CMS regulations, Eden Prairie, MN, Minnesota, telecommute, work from home