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The Program Manager Revenue Integrity plays a vital role within the organization. The primary focus is upon insuring patient eligibility integrity and accurate revenue results for two client IPA’s.

If you are located in Oxnard, CA, you will have the flexibility to work from home and the office in this hybrid role* as you take on some tough challenges.

Primary Responsibilities:

• Monitors the daily operations of the department including all workflows, turnaround times, production levels, and staffing needs within budgetary and business planning guidelines

• Compiles and analyzes monthly enrollment data to provide accurate enrollment schedules to various departments including Financial Analysis, Accounting, Provider Contracting, etc.

• Prepare, analyze, and monitor eligibility reconciliations to ensure that all exceptions and rejected data have been researched and updated

• Assist and ensure that programming changes are requested, justified, and implemented properly for the business unit's eligibility manager software

• Calculates and prepares client provider capitated payments monthly in line with contract timelines and requirements

• Effectively and professionally communicate results, challenges and solutions through daily interaction and regular reports with management

• Create and monitor standard reports to identify anomalies and/or trends impeding appropriate revenue capture. Take action to identify issues and pursue payors to ensure correct payments are being made

• Responds timely and effectively to requests from other departments as they relate to the functions of the Eligibility department

• Manages revenue reconciliation by obtaining and monitoring daily revenue activity

• Manage and train staff of four

• Creates, analyzes, ad hoc reports to ensure all revenue is accounted for, and paid according to contract. Partners with finance to understand variances, and fluctuations in revenue received

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:

• 2+ years of experience in eligibility and capitation management

• Ability to demonstrate strong proficiency using MS Suite and other systems

• Knowledgeable of accounting/revenue functions

• Solid analytical and problem-solving skills

• Ability to follow verbal and written instructions

Preferred Qualifications:

• Knowledge of eligibility/insurance verification and managed care administration

• MS SQL

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

California Residents Only: The salary range for this role is $48,300 to $94,500 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

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.