The Mandate: Stand Up, Transform, OperateStand up the Center of Excellence- Complete current-state assessment across all of our client back ends using a phased, risk-based approach that prioritizes critical clients rather than attempting simultaneous discovery
- Design and ratify the future-state operating model: functional architecture, decision rights, escalation paths, and the boundary between enterprise standard and legitimate client-specific requirement
- Build the COE from the ground up across all four pillars - People, Process, Technology, and Metrics - including charter, org design, leadership roles, SOP library, playbook content, and reporting infrastructure
- Establish the enterprise A/R and denial data foundation, including ambulatory A/R visibility that does not exist in current telemetry, and define the source of truth for every metric the COE will be measured on
- Sequence and execute five CDL-to-COE transition waves, beginning with the largest and least globalized client portfolio, and absorb the readiness dependencies that come with it - EHR access approvals, trainer certification, and client-side IT capacity
Transform the work- Convert eleven inherited operating models into one: standardized CARC/RARC taxonomy, a single work queue methodology at payer and tier level, redesigned claim and account flow, and centralized master billing edits
- Shift the model from reactive collection to prevention - a front-end-heavy, back-end-lean revenue cycle in which claims do not leave the door until they are clean, and in which denial root cause is routed back to registration, financial clearance, and coding through a governed feedback loop
- Design the specialty delivery organization and the tiered work model that underpins it: low-complexity work concentrated for automation and scale, high-complexity work reserved for the most capable resolvers, with productivity benchmarks and quality controls defined for each tier
- Own the back-end automation and AI agenda - including the automation opportunity pipeline already identified across the portfolio - and translate operational requirements into product and engineering roadmaps rather than accepting whatever the roadmap delivers
- Execute globalization at pace without sacrificing performance, recognizing that client portfolios range from fully un-globalized to substantially complete and require materially different transition designs
Operate at enterprise scale- Carry weekly and monthly performance accountability for cash, days in A/R, denial rate, appeal outcomes, inventory clearance, quality, and cost to collect across all eleven clients
- Run a disciplined operating rhythm - dashboards, executive scorecards, root-cause action plans, quarterly business reviews - in which decisions are made against the scorecard rather than merely reported on it
- Make and defend explicit tradeoffs between cash velocity and denial control, and articulate to clients and to enterprise leadership why a given operating point was chosen
- Establish and sustain the maximum-performance discipline: define the theoretical ceiling by client and payer segment, expose the constraints holding performance below it, and distinguish strategic tradeoffs from habit and technology debt
Organization to Be Designed and BuiltThe COE will be organized by specialty rather than by client. This leader is accountable for designing the structure, defining the role architecture, and hiring or developing the leadership bench for each tower:
- Billing and Clean Claim Execution - claim edits, holds, rejects, and pre-submission accuracy
- A/R Follow-Up and Collections - tiered resolution teams across payer, patient, and self-pay balances
- Denial Management and Appeals - technical and administrative denials, appeal strategy, and the prevention feedback loop
- Underpayment Recovery - contract variance identification and recovery execution
- Cash Posting, Reconciliation, and Credit Balance Management - including credits, refunds, and unapplied cash
- Correspondence - intake, classification, routing, and automated document handling
- Transition and Readiness Office - wave planning, current-state assessment, cutover, and stabilization
- Performance, Quality, and Analytics - standards adoption, quality audit, benchmarking, and executive reporting
- Managed Care Payer Trend Identification and Payer Strategy - a longer-horizon capability that will detect payer behavior shifts, adjudication pattern changes, and emerging denial trends across the enterprise book of business, and convert them into pre-emptive operational and contractual action. This is the capability no single-client operation can build, and it is intended to become a durable competitive advantage
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 Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.
Primary Responsibilities: Enterprise operating model and decision rights- Define what the enterprise does the same way every time, what may vary, and who is authorized to grant an exception - then hold the line when exceptions are requested for reasons of preference rather than requirement
- Publish and maintain enterprise standards: SOPs, work queue methodology, CARC/RARC mapping, appeal templates, productivity and quality benchmarks
- Move execution decisions closer to the work within clear guardrails, so that scale does not create bottlenecks at the center
Mutli-client transition leadership- Lead eleven concurrent or sequenced back-end transitions from client-dedicated delivery into the COE, separating lift-and-shift readiness from transformation readiness so that neither blocks the other
- Hold governance sign-off on future-state design per client before cutover, and own stabilization commitments after it
- Manage the second-order consequences of transition: retention risk in transitioning teams, knowledge capture from departing subject matter experts, and client confidence during the disruption window
Cash, denial, and inventory performance- Own net revenue realization and cash acceleration across the portfolio, with a target of materially reducing time to collect through centralized billing edits, work queue redesign, and SOP standardization
- Drive clean claim performance to and beyond the enterprise standard, and reduce initial and preventable denials through upstream correction rather than downstream rework
- Manage aged inventory deliberately - aged trial balance analysis by payer and aging bucket, clean-claim and days-to-pay benchmarks per payer per client, and prioritized deployment of capacity against the highest-yield accounts
Technology, automation, and AI enablement - Set the back-end technology path and drive convergence toward it, including standardization within Epic and the retirement of legacy billing platform variation
- Prioritize and sponsor the automation portfolio, define human-in-the-loop controls and exception handling, and validate benefit realization rather than accepting projected run rate
- Partner with Product, Engineering, and Automation leadership to align roadmaps to COE priorities - and escalate credibly when they are not aligned
- Sponsor AI-enabled quality assurance, denial and appeal drafting, and predictive cash and A/R analytics, with the governance and audit posture those capabilities require
Global delivery, vendor, and workforce strategy- Design the domestic and global delivery footprint, including role tiering, span of control, career architecture, and capability development aligned to work complexity
- Govern global delivery partners and third-party vendors to enterprise performance standards, and drive dependency reduction in partnership with the Vendor Strategy COE
- Lead workforce transition with the transparency and rigor that large-scale role change demands, in coordination with Human Capital, Communications, and client leadership
Client and executive engagement- Serve as the senior Optum back-end voice with health system CFOs and revenue cycle executives - translating operational design into financial outcome, and absorbing pressure without absorbing scope creep
- Represent the enterprise model in new-business pursuits and expansion conversations, and convert operational proof points into commercial credibility
- Lead payer dispute escalation strategy and coordinated remediation across clients where a shared payer behavior is driving shared loss
Risk, compliance, and controls- Maintain audit readiness across cash handling, adjustment authority, credit balance resolution, and refund compliance
- Ensure responsible AI and automation practice, including documented controls, human review thresholds, and model performance monitoring
- Identify and remediate revenue leakage drivers, with particular attention to adjustment accuracy and write-off governance
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:- 15+ years of progressive revenue cycle leadership, with deep operating expertise across A/R, denials, underpayments, and cash management
- 10+ years leading large, matrixed organizations across domestic, global, and vendor-based delivery, including responsibility for leaders of leaders
- Track record of managing a multi-hundred-million A/R portfolio with accountable cash and denial outcomes
- Deep command of CARC/RARC-driven denial management, payer contract mechanics, work queue architecture, and billing edit design
- Proven ability to translate EHR and billing platforms - Epic in particular, alongside legacy environments such as eFR, Invision, and STAR - into scalable operational and automation design
- Experience operating in a multi-client outsourced or managed services environment with contractual SLA exposure, or equivalent experience leading revenue cycle across a multi-hospital health system with independent site operations
- Executive presence and credibility with health system CFOs, including the ability to hold a difficult performance conversation without losing the relationship
- Demonstrated capability building data and KPI frameworks where none existed, and using them to drive sustained improvement
Preferred Qualifications:- Experience standing up a Center of Excellence or shared services organization from a blank page
- Global delivery leadership experience, including offshore and nearshore transition at scale
- Managed care or payer-side experience, or demonstrated capability building payer intelligence and trend detection functions
- Fluency with AI-enabled operations, including human-in-the-loop design, model governance, and benefit validation
- Demonstrated experience consolidating multiple independent back-office or central billing operations into a single standardized operating model - not participation in such a program, but ownership of one
- Structured problem-solving credentials (Lean, Six Sigma) and experience with RPA-enabled workflow design
- Experience in a transformation environment where the operating model was changing while performance commitments remained fixed
*All employees working remotely will be required to adhere to UnitedHealth Group ' s Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $200,400 to $343,500 annually based on full-time employment. We comply with all minimum wage laws as applicable.
