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Job Details


UnitedHealth Group

Associate Director of Submission Services - Telecommute

Restaurant and Food Services

Associate

Yearly

No

Irvine, California, United States

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

The Associate Director of Submission Services will lead a national operations team responsible for managing submissions of Medicare Advantage encounter data for our Care Delivery Organizations. This position will contribute to the complete and accurate reporting of patients’ health care status by ensuring more than 250M transactions are processed correctly and submitted timely to more than 30 Medicare Advantage Organizations including United Healthcare.

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

Primary Responsibilities:

  • Formulate strategic and operational objectives to achieve volume throughput and efficiencies
  • Manage budgets and forecasts
  • Ensure all operations are carried on in an appropriate and compliant way
  • Ensure system and process controls are executed and monitored
  • Maintain appropriate Policies and Standard Operating Procedures
  • Maintain all user documentation and work instructions
  • Recruit, train and supervise staff and daily work assignments
  • Manage receipt and processing of annual volumes exceeding 250M transactions
  • Improve performance of staff by ensuring staff remain current on compliance, regulatory, and best practice guidelines and are well versed in industry standard subject matter
  • Establish and implement productivity measures, perform quality controls, and monitor production KPIs and SLAs
  • Provide Care Delivery Organization support by managing special projects, identifying and resolving submission issues, and conducting monthly business review with our Risk Adjustment partners

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:

  • Bachelor’s Degree or equivalent job experience
  • 7+ years of experience managing work in transaction processing systems, associated rules driven decision handling, error handling, and end-to-end reconciliation with proven understanding of each
  • 5+ years of provider (billing) or payer (adjudication) claims experience including proven understanding of appropriate coding nomenclature usage, standards, and guidelines
  • 5+ years of Risk Adjustment experience with proven understanding of payment models and encounter data submissions
  • 5+ years of EDI/B2B experience including network and transmission protocols, ANSI standard transactions, data mapping
  • 3+ years managing mid-to-large sized teams
  • 3+ years preparing and delivering executive level presentations, reports, and communications
  • 3+ years managing operations including budgeting, forecasting, and preparing staff models
  • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation

Preferred Qualification:

  • BA or PMP Certification a plus

Knowledge/Skills/Abilities:

  • Knowledge of health insurance industry standards and practices
  • Knowledge of claims billing, and/or claims adjudication standards and practices
  • Knowledge of industry standard coding nomenclatures including appropriate usage
  • Knowledge of Electronic Data Interchange protocols and best practices
  • Knowledge of ANSI transaction sets including 837
  • Knowledge of Risk Adjustment
  • Knowledge of CMS Encounter Data Submissions
  • Adaptability to shifting priorities and ability to adjust initiatives and priorities accordingly
  • Ability to manage medium sized teams

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment

Careers at OptumCare. We're on a mission to change the face of health care. As the largest health and wellness business in the US, we help 58 million people navigate the health care system, finance their health care needs and achieve their health and well-being goals. Fortunately, we have a team of the best and brightest minds on the planet to make it happen. Together we're creating the most innovative ideas and comprehensive strategies to help heal the health care system and create a brighter future for us all. Join us and learn why there is no better place to do your life's best work.(sm)

OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare’s support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $97,300 to $176,900. The salary range for Connecticut/Nevada residents is $97,300 to $176,900. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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.

Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment

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