Director of Payment Integrity

Medical Mutual of Ohio • Brooklyn, OH

401d

About The Position

The Director of Payment Integrity is responsible for overseeing the processing and auditing of financial disbursements for all Plan claims and provider reimbursements, ensuring regulatory compliance. This role involves developing strategies to enhance payment accuracy, minimize financial losses, and collaborating with key stakeholders across the organization.

Requirements

• Bachelor's degree in business administration, finance, or related field; Master's Degree preferred.
• 8 years progressive experience in healthcare operations (payer or provider) or consulting, including financial information systems, and claims payment review and disbursement, with 5 years in a management capacity.
• Thorough knowledge of medical/claims procedures, terminology, payment analysis, and claims processing systems.
• Knowledge of health plan operations and regulations.
• Proficiency with Microsoft Office and database reporting.
• Strong communication and presentation skills.
• Strong financial analysis and business acumen.
• Strong vendor relations and negotiation skills.

Nice To Haves

• Experience with Robotic Process Automation (RPA) and Artificial Intelligence (AI) technologies.
• Familiarity with Optical Character Recognition (OCR) systems.

Responsibilities

• Lead operations and staff responsible for health plan payment integrity, ensuring regulatory compliance along with payments and remittances to provider partners.
• Develop and lead efforts to support medical cost initiatives in partnership with stakeholders across the organization.
• Bring efficiency to workflow through process improvement and transformative technologies including Robotic Process Automation (RPA), Optical Character Recognition (OCR), and Artificial Intelligence (AI).
• Collaborate with various internal departments to ensure data integrity and proper processing of financial transactions.
• Direct the development, implementation, and maintenance of the corporate disbursements system, ensuring data integrity and financial controls.

Benefits

• Employee bonus program.
• 401(k) with company match up to 4% and additional company contribution.
• Health Savings Account with company matching contribution.
• Excellent medical, dental, vision, life, and disability insurance.
• Access to an Employee Assistance Program.
• Company holidays and up to 16 PTO days during the first year of employment.
• Parental leave for eligible employees after 120 days of service.
• Career development programs and classes.
• Tuition reimbursement up to $5,250 per year.

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree
• Number of Employees: 501-1,000 employees