Strategic Solutions Consultant – Payment Integrity – Remote

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.

This position will serve as a payment integrity subject matter expert within the Optum Go To Market organization. The role involves collaborating with market, growth, and product teams to support growth and renewal strategies for Optum’s Payment Integrity services and software portfolio. Key responsibilities include developing and presenting client-specific solutions, managing stakeholders through the contract lifecycle, and ensuring proposals include the correct solution mix, pricing approach, and value story. Additionally, the role involves providing voice-of-customer feedback, reviewing new solution concepts, identifying target customers, and helping launch new products to the market

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

Primary Responsibilities:

This role serves as a payment integrity subject matter expert within the Optum Go To Market organization. Key responsibilities include:

• Collaborating with internal cross-functional teams, including internal market, growth, and product teams and external business partners to support growth and renewal strategies, strategic programs and initiatives for Optum’s Payment Integrity services and software portfolio
• Developing and presenting client-specific solutions, managing stakeholders through the contract lifecycle, and ensuring proposals include the correct solution mix, pricing approach, and value story
• Providing voice-of-customer feedback, reviewing new solution concepts, identifying target customers, and helping launch new products to the market
• Developing, implementing, and managing multi-year projects and programs
• Working across matrix organization to develop, test, and refine implementation strategies for new-to-market solutions, business partnerships, and training staff on new go-to-market approaches
• Managing relationships with key stakeholders to ensure all internal team needs are met prior to and post-implementation
• Applying advanced analytical and quantitative approaches to problem-solving for large complex clients with multiple lines of business and/or products and/or new-to-market solutions
• Using communication skills to influence and negotiate
• Working directly with customers to define other project requirements
• Supporting Optum Business Partners with questions around integration
• Compiling documentation: processes and procedures (including but not limited to client or system-specific tracking)
• Prioritizing projects and outcomes identified by the Executive Team
• Providing insight related to savings targets, budget and forecasting, and increased medical and administrative savings opportunities
• Driving execution on new sales opportunities and developing new pricing models for emerging products and content, including sales presentations, RFP responses, and providing expertise in pricing new deals and renewals as well as more complex vendor and tri-party agreements
• Ensuring that contracts are reviewed and represent the best interest of the business

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 program management experience
• Health plan experience in facility contract configuration, claims or IT
• Experience documenting client operational and technical workflow
• Intermediate  knowledge and understanding of facility and professional reimbursement – includes DRG, APC, OCE, ESRD, CAH, CMG, RUG, RBRV
• Claims system knowledge – Trizetto Facets, QNXT, HealthEdge Health Rules Payer /, IKA Claims,  Epic Tapestry, 3M, RAM HealthSuite, Conduent/HSP MediTrac preferred
• Payment Integrity system/service knowledge – Cotiviti, Zelis, HealthEdge Source, Machinify
• Understanding of healthcare industry regulations and compliance requirements
• Proven solid background in financial analysis and cost-saving initiatives
• Proven excellent verbal and written communication skills. Ability to influence and negotiate effectively
• Willingness and ability to travel up to 25%

Preferred Qualifications:

• 10+ years of payment integrity program management experience
• Experience with policy-related decisions and facilitating conversations with decision makers
• Account management experience
• Project management experience
• Proven experience in leading cross-functional teams and managing large-scale projects
• Knowledge of emerging trends and technologies in healthcare payment integrity
• Proven track record in managing executive initiatives and driving strategic projects

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy 

The salary range for this role is $124,500 to $239,400 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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 marginalized 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.

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.