M&R Policy Creation Manager

About the Role

Join Optum, a global health services organization dedicated to enhancing lives through technology and care. This position involves working within the Reimbursement Policy team to craft and maintain UnitedHealthcare reimbursement policies, initiate projects, monitor third-party sources for alignment, ensure coding updates implementation, and identify reimbursement opportunities. The role offers a hybrid model for employees based in the Republic of Ireland, allowing split work hours between the Dublin or Letterkenny office and home-based telecommuting.

Key Responsibilities

• Collaborate with other Reimbursement Policy managers to sustain and support timely reimbursement policy updates and coding implementation for UnitedHealthcare.
• Lead various stages of reimbursement policy creation and execution, including preparing documentation, delivering presentations to large audiences, and drafting business requirement documents.
• Evaluate and manipulate extensive data sets effectively.
• Provide expert guidance on coding and reimbursement policies within UnitedHealthcare departments.
• Ensure claims processing adheres strictly to reimbursement policies.
• Analyze third-party publications and resources to stay updated on reimbursement and coding standards.
• Represent reimbursement policy functions, serving as a subject matter expert for related initiatives.
• Create and maintain departmental materials.
• Collaborate across multifunctional teams to drive initiatives.
• Consistently promote affordability projects impacting various business areas.
• Develop innovative solutions and approaches within the reimbursement policy domain.

Required Qualifications

• High School Diploma or GED equivalency.
• CPC certification.
• Experience with CMS methodologies, reimbursement research, and procedures.
• Familiarity with CES, ARU, and SAM editing to support payment policies.
• Working knowledge of claims platforms such as Cosmos, CSP, and/or NICE.
• Intermediate skills in Microsoft Excel and Word including pivot tables, data handling, formulas, document reviewing, and formatting management.

Preferred Qualifications

• Bachelor's degree or higher education.
• Proven project management experience.
• Knowledge of Fraud, Waste, and Abuse (FWA) recovery concepts.
• Understanding of professional and facility claim reimbursement processes.
• Experience in business requirements documentation.
• Proficiency in OneNote and PowerPoint.
• Experience in designing and managing CES editing for reimbursements.
• Ability to simultaneously oversee multiple projects and affordability initiatives.
• Competence in interpreting financial reports and performing data manipulation.
• Experience in reimbursement policy writing.

Soft Skills

• Strong capability to manage and prioritize several projects and track affordability initiatives effectively.
• Excellent business writing aptitude for leadership communication.
• Skilled in coordinating with Payment Integrity leadership and cross-functional teams.
• Clear and concise verbal and written communication skills.

Additional Information

Applicants must be eligible to work indefinitely in Ireland without restrictions and provide proof upon request. UnitedHealth Group is dedicated to promoting diversity, equity, and inclusion, supporting health equity globally, and maintaining an inclusive workplace environment. The company operates as an equal opportunity employer and a drug-free workplace.