Director Payor Solutions Compliance – 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.

The Director of Payor Solutions Compliance will be a dynamic and hands-on leader to join our team. This person will be tasked with developing and implementing strategies that will ensure service excellence, project success and growth, team collaboration, and overall operational health, including escalations for the top Managed Care Payers including JOC Payer Projects, Settlements, Litigation, Arbitration, Bankruptcies. This role will have both strategic and tactical responsibilities for ensuring the hospital’s adherence to all contractual, regulatory, and operational requirements related to managed care payors. This role serves as the primary liaison between Revenue Cycle operations and managed care contracting, ensuring that payor agreements are operationalized effectively and that the organization remains compliant with evolving payor policies, federal/state regulations, and internal standards.

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

Primary Responsibilities:

• Compliance Oversight:
  • Provider / Payer contract compliance 
• Payor Relationship Management:
  • Serve as a key point of contact for Managed Care Contracting regarding compliance-related issues
  • Collaborate with Managed Care Contracting to review and interpret contract language for operational feasibility and compliance implications
• Revenue Integrity & Risk Mitigation:
  • Partner with Revenue Integrity, HIM, and Patient Financial Services to ensure accurate charge capture, coding, and billing practices
  • Develop and implement corrective action plans for identified compliance issues or audit findings

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:

• 5+ years of managed care contractual agreements, able to read, interpret and apply contract to billing. Including payer policies and provider manuals 
• 5+ years of experience working with hospitals and operations or clinical professionals
• 5+ years of experience analyzing large data sets to identify trends, develop baselines, and track improvement 
• 5+ years of experience creating presentations demonstrating outcomes and presenting in-person or remotely to executive audiences
• 3+ years of experience in Healthcare Revenue Cycle including Denials Management and Payor Appeals
• 3+ years of experience working with Patient Financial Services, Business Office, Insurance claim billing, Collections, Reimbursement, Patient Access, Coding
• 3+ years of experience in denial prevention operations and/or process improvement methodologies
• 3+ years of experience presenting to executive level audiences
• 3+ years of Project Management experience with an understanding of action items, next steps, assignment of tasks, measuring improvement, holding others accountable
• 3+ years of experience with documenting processes and practices (process maps, job aids, instructions)
• 2+ years of experience with government or non-government auditing and reimbursement
• Ability to travel to the west coast as needed (25-50%)

Preferred Qualifications:

• Six Sigma or Lean Sigma certification, training, or experience
• 10+ years of progressive operations leadership experience, including revenue cycle leadership in a hospital or healthcare provider setting
• Industry Knowledge: In-depth knowledge of healthcare revenue cycle trends, including current regulatory, market, and customer trends
• Contract Management including expansion, execution and scope management within Master Service Agreements (MSAs)
• Innovative/Entrepreneurial Thinking: Demonstrated ability to work in an environment that requires innovative thinking and rapid cycle turnaround
• Hands-on management approach
• A focus on service excellence, continuous improvement, and growth
• Policy Awareness: Knowledgeable in current and potential future policies, trends, and information affecting healthcare revenue cycle
• Technical Proficiency: Proficient in Microsoft Office applications.
• Remote Leadership: Ability to work remotely and lead diverse teams

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

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 $110,200 to $188,800 annually based on full-time employment. We comply with all minimum wage laws as applicable.

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.