You are a thought leader who thrives on developing new solutions to solve tough challenges. As a critical member of our business analysis team, you will help rewrite the future of UnitedHealth Group. Here, your analytical and innovative skills will help us with our mission of helping people live healthier lives. Yes, we share a mission that inspires. And we need your organizational talents and business discipline to help fuel that mission. Are you ready to analyze data and deliver bold, business - savvy ideas to impact the lives of millions? This newly created position of Regional Revenue Integrity Leader, will be aligned to a grouping of States by designated geographic region. Will serve as the primary leader in support of ensuring the State eligibility and payment files are reconciled and optimized to ensure revenue integrity. Will operationalize and optimized a sustainable, E2E revenue reconciliation process across multiple states and for new business. This role will work directly with the Health Plan State CEOs, COOs, CFOs, the State eligibility and payment processing teams, Operations, IT and Finance. Will build effective process controls, maintain consistent documentation controls, will develop and report according to stakeholder needs and will leverage Advanced Research and Analytics to build industry leading analytic, data cleanse and input control capabilities. This position will engage in large scale, dynamic, processes in parallel and will span multiple constituencies. Will require Operations, Process, Analytic, Technology, Reporting and Financial interpretation. Will be a heavily matrix relationship role and requires organizational agility and strong communication skills. Primary Responsibilities:Build and streamline an E2E Revenue Reconciliation process between multiple Health Plans / States, Operations and Finance Develop input and output controls, leveraging Advanced Analytic capabilities for data cleanse and quality control Create process control to ensure sustainability and repeatability Regular and consistent contact with state leadership on all eligibility and revenue related projects / issues and discrepancies Monitors all state changes that affect revenue - including but not limited to: benefit changes; new enrollment categories or subsets of membership; Pass through monies that require operational changes Directs and oversees cross functional changes / improvements between functional areas including processes that impact multiple markets Monitors, directs, and oversees collaboration and coordination of processes between enrollment and revenue team. Insures that financial operations processes support accurate collection of premium Monitors all cross functional transactions, including IT file transactions, to insure consistency in application and accuracy in handoffs Insures the implementation of processes for monitoring and auditing file loads and downloads and insures consistency in application of processes Build reporting to meet all internal and external stakeholder needs for ongoing reconciliation, retro reconciliation and maintenance Proactively initiate and develop strategies to drive change in processes, tools and capabilities that increase efficiency and effectiveness, while concurrently improving the state experience and complying with regulatory requirements Collaborate with key internal and external business partners to stay abreast of changes in the Medicaid, regulatory and individual marketplace. Proactively communicate and drive strategic and operational plans to achieve the required operational results Insures the reconciliation of member eligibility to revenue receipt for each member, each month. Oversees the research of issues identified through RAM reporting or other sources to identify root cause. Develops systematic processes to remediate process issues and improve results Develop and insure that consistent / repeatable processes are in place between revenue team, enrollment team and health plan team to correct record errors that are resulting in non - payment or underpayment Anticipates customer needs and proactively develops solutions to meet them Serves as a key resource on complex and / or critical issues Solves complex problems and develops innovative solutions Performs complex conceptual analyses Reviews work performed by others and provides recommendations for improvement May lead functional or segment teams or projects Provides explanations and information to others on the most complex issues Motivates and inspires other team members Must be able to travel 10 - 15% throughout the US
Required Qualifications:Undergraduate degree or equivalent experience 1+ years of health insurance operations, financial services or other operational environment experience Demonstrate strong communication skills (verbal, written) Ability to create, analyze, interpret and report on outcomes and variances Advanced level of proficiency with MS Word, Project, Excel and PowerPoint Demonstrate and apply understanding of health care industry trends and their drivers Demonstrate and apply knowledge of technology industry trends and tools Demonstrate and apply understanding of applicable regulations (e.g., HIPAA, SOX) and UHG policies / standards Demonstrate understanding of the difference between business requirements and technical solutions Maintain awareness of best practices / approaches related to the business analysis discipline Ability and willingness to travel 10 - 15% of timePreferred Qualifications:Medicaid, government or health plan experience Proven skills in operational process and systemic improvementCareers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.(sm) 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: Revenue Integrity Regional Leader, Insurance, HIPAA, SOX, Minnetonka, MN, Minnesota, Telecommute, Telecommuter, Telecommuting, Remote, Work from home
Our mission is to help people live healthier lives and to help make the health system work better for everyone.
- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities.
- We work with health care professionals and other key partners to expand access to quality health care so people get the care t...hey need at an affordable price.
- We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.