Director Payer Solutions - Remote

Overview

Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives?

Join us to start Caring. Connecting. Growing together.

You believe data can help reshape the future, and you love the thrill of challenging analysis. At United Health Group, you’ll find an organization that recognizes those talents and offers growth potential. Here, you will be empowered, supported, and encouraged to use your analysis expertise to help change the future of health care.

The Director Payer Solutions position is responsible for managing payer escalations, settlements, and contract compliance within the Payer Solutions team. This role works with revenue cycle stakeholders, client executives, and payer leadership to address complex matters and support payer performance.

The Director Payer Solutions provides assistance to the Payer Solutions Team, focusing on customer service for the Client Contracting Team, Client Executives, Client CFOs, and Internal O360 Revenue Cycle Teams. Responsibilities include oversight of Payer Project Escalations for major Managed Care Payers, including JOC Payer Projects, settlements, litigation, arbitration, and bankruptcies. The position involves collaboration across the revenue cycle and requires meetings with Payer Leadership, Contracting, VPs, CFOs, and Revenue Cycle Stakeholders.

You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.

• Serve as subject matter expert on payer contracts, reimbursement policies, and UB-04 claim guidelines. Subject matter expert with contract language
• Expert in contract interpretation and contract language application to accounts receivable and issue identification.
• Expert in UB-04 claim editor guidelines, timely/appeal guidelines, CMS guidelines, and payer reimbursement processes to ensure accountability and compliance
• Expert in calculating expected reimbursement based on charges billed on UB-04 forms and the negotiated contract between the payer and Dignity Health, applying all terms and considerations, including CMS guidelines and payer policies
• Solid ability to identify and validate poor payer behavior, analyze accounts receivable and applying contract, policy and provider manuals to strengthen rebuttal against payer. Create trending payer projects
• Manage payer escalations, litigation support, bankruptcies, and settlements from start to finish
• Prepare and deliver professional presentations and reports using Excel, Power BI, and Power Point
• Collaborate with contracting and finance teams during renewals and audits; provide payer overviews and analytics
• Maintain accurate reporting (DH91, WINs, Executive Committee updates) and facilitate payer learning sessions
• Drive process improvements across the revenue cycle using Six Sigma methodologies
• Support data compilation for arbitration, litigation, and contract negotiations
• Ensure compliance with CMS guidelines and payer policies; escalate unresolved issues per client protocols
• Prepare and present highly professional presentations for Managed Care Payer Leadership, Contracting, VPs, CFOs, Revenue Cycle Stakeholders, and client CFOs using Microsoft PowerPoint, Power BI, and Excel. Presentations include organized Pivot Tables summarizing data
• Point of contact for Client Contracting/PSR Team. Field all data requests, reporting asks. Ability to understand the client ask and provide further insight/questions to ensure alignment.
• Run reports from PIC identifying the key data elements needed to quantify AR impact. Submit tickets and work with Optum BIA Reporting Team
• Facilitate start to finish of settlements from data capture, presentation to the client,…