Transforming health care and millions of lives starts with the values you embrace and the passion you bring. Find out more and join us. It's an opportunity to do your life’s best work.(sm)
The Medical Director, Payment Integrity is responsible for providing expertise and general support to teams in reviewing, researching, investigating, negotiating and resolving all types of aberrant claims and utilization issues. They will communicate with appropriate parties, including but not limited to providers, vendors, and health plans regarding appeals, grievances and provider reconsideration requests. This individual will assist analyze and identify trends to address root causes and eliminate rework that is costly in terms of both dollars and working relationships. This role may research and resolve claims-related written Department of Insurance complaints and complex or multi-issue provider complaints submitted by consumers and physicians/providers.
The Medical Director will work to assist in the development and maintenance of relevant algorithms and methodologies to sustain a claims anomaly surveillance system; identify trends, outliers of concern, and improvement opportunities. They will be responsible for investigating and resolving all types of claim aberrancies as well as recovery and resolution for health plans, commercial customers, and government entities. This role will also review claims and medical documentation for medical necessity for claims CPT code usage, and for edits set for reviews by Claims and Payment Integrity team.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Personal and Physician Development
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.
UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.
Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 550,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
Colorado Residents Only: The salary range for Colorado residents is $254,600 to $295,200. 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: 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.