Payment Integrity Manager

Role Overview

• Ensure the accuracy of claims payment through management of a robust process
• Coordinate and respond to inquiries from executives
• Handle the processing and management of Payment Integrity waivers
• Assist in preparing responses to Requests for Proposals across all lines of business
• Document process flows accurately
• Help with preparing presentations
• Review and approve performance guarantees
• Evaluate regulatory compliance and Health Care Reform changes
• Monitor provisions of the compliance plan
• Develop and analyze monthly reports
• Develop project plans and oversee project execution

Requirements

• Requires a BA/BS in business, engineering, nursing, finance, or healthcare administration
• Minimum of 5 years related work experience
• Minimum of 2 years leadership experience
• 2-5 years of experience with Fraud, Waste and Abuse preferred
• Experience with payment integrity preferred
• Familiarity with claims systems and processes preferred
• Experience with GBD Facets preferred

Benefits

• merit increases
• paid holidays
• Paid Time Off
• incentive bonus programs
• medical benefits
• dental benefits
• vision benefits
• short and long term disability benefits
• 401(k) +match
• stock purchase plan
• life insurance
• wellness programs
• financial education resources