Supervisor, Revenue Integrity & Analytics - 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 Revenue Integrity Supervisor is responsible for overseeing West revenue integrity processes to drive appropriate reimbursement, pricing accuracy, transparency and expertise for charge capture.

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 Las Vegas , you will be required to work in the office a minimum of 2 times a month or PST working hours 8 am to 5pm Monday Thru Friday

• Supervises daily revenue integrity operations, including payer payment and pricing applications, charge control processes, system updates as needed
• Maintains the charge master and fee schedules for West Region; completes annual and quarterly updates; documents approved changes; and coordinates annual CDM CPT/HCPCS updates
• Monitors charge-capture controls, including revenue reconciliation, change management, and supports departmental accountability for complete and accurate charges
• Reviews, works, and resolves Epic charge-related work queues and billing edits accurately and within established turnaround times
• Partners with Coding and clinical departments to identify and correct charge, billing, documentation, and coding errors in accordance with ICD, CPT, HCPCS, payer, and National Correct Coding Initiative requirements
• Serves as the primary service-line resource for charge-related questions, charge-code use, payer coverage, and payment requirements
• Identifies opportunities to optimize practice management and revenue cycle technology, integrate business intelligence tools, automate manual processes, and standardize reporting across the West
• Analyzes, validates, and distributes KPI dashboards, quality-control reports, monthly operational reports, and ad hoc analyses for Revenue Cycle, Finance, Clinical Operations, and other stakeholders
• Analyzes charges, payments, denials, and reimbursement trends to identify revenue gaps, short payments, noncompliance, and opportunities to accelerate collections and prevent revenue loss
• Conducts routine claim and charge master reviews, coordinates complex denials and payer audits, and escalates or troubleshoots claim and reimbursement issues with payers
• Monitors Medicare, Medicaid, and commercial payer guidance and medical policies; evaluates operational and financial impacts; and implement approved compliance changes with Revenue Integrity and operational leaders
• Meets with operational leaders to review revenue cycle metrics, identify trends and issues, and develop interim and long-term improvement plans
• Supports payer contract configuration in practice management systems and monitors payments against contractual terms to identify reimbursement variances
• Participates in revenue cycle improvement initiatives and completes other duties or projects that support organizational goals

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

• 2+ years of experience in Healthcare Revenue Cycle Operations including…