Payment Integrity Medical Director

Are you looking for a challenging and rewarding career in the healthcare industry? Do you have a passion for promoting payment integrity and ensuring the highest quality of care for patients? If so, UnitedHealth Group is seeking a highly qualified and motivated individual to join our team as a Payment Integrity Medical Director. As the Payment Integrity Medical Director, you will play a crucial role in identifying and addressing potential fraud, waste, and abuse in the healthcare system. This position requires a strong knowledge of healthcare regulations and policies, as well as excellent communication and leadership skills. If you are a dedicated and driven individual with a commitment to improving healthcare, we encourage you to apply for this exciting opportunity.

1. Develop and implement strategies to identify and prevent fraud, waste, and abuse in the healthcare system.
2. Review and analyze claims data to identify patterns and trends that may indicate potential fraudulent activity.
3. Collaborate with internal and external stakeholders to investigate potential cases of fraud, waste, and abuse.
4. Work closely with legal and compliance teams to ensure adherence to healthcare regulations and policies.
5. Provide guidance and training to staff on payment integrity processes and procedures.
6. Serve as a subject matter expert on payment integrity and healthcare regulations.
7. Participate in the development and implementation of new payment integrity initiatives.
8. Monitor and report on the effectiveness of payment integrity programs and make recommendations for improvements.
9. Communicate with healthcare providers and payers to resolve billing and coding discrepancies.
10. Conduct audits and reviews to ensure compliance with payment integrity regulations and policies.
11. Stay up-to-date on changes in healthcare regulations and policies related to payment integrity.
12. Represent the company in meetings and conferences related to payment integrity.
13. Lead and manage a team of payment integrity professionals.
14. Provide timely and accurate reports and updates to senior management.
15. Uphold the company's mission and values in all interactions and decisions.

According to JobzMall, the average salary range for a Payment Integrity Medical Director in San Antonio, TX, USA is $220,000 - $270,000 per year. However, this can vary depending on factors such as the size and type of the company, the individual's level of experience and education, and other benefits such as bonuses and stock options. It is always best to research and negotiate with the specific company for a more accurate salary range.

UnitedHealth Group Incorporated is an American for-profit managed health care company based in Minnetonka, Minnesota. UnitedHealth Group, Inc. provides health care coverage, software and data consultancy services. It operates through the following segments: UnitedHealthcare, OptumHealth, OptumInsight, and OptumRx. The UnitedHealthcare segment utilizes Optum's capabilities to help coordinate patient care, improve affordability of medical care, analyze cost trends, manage pharmacy benefits, work with care providers more effectively, and create a simpler consumer experience.