Manager, Payment Integrity - REMOTE
About The Position
Leads and manages a team responsible for payment integrity activities, including recovery operations. The manager is accountable for team performance and quality and establishes procedures and techniques to meet payment integrity operational standards and production targets. The role oversees day-to-day operations for assigned payment integrity programs, develops staff, monitors quality and performance, improves workflows, collaborates with internal departments and vendors, analyzes operational data, supports regulatory compliance, and contributes to process-improvement projects.
Requirements
- At least 7 years of experience supporting health care operations, including 4 years of payment integrity or claims experience, or an equivalent combination of relevant education and experience.
- At least 1 year of management or leadership experience.
- Ability to establish and maintain positive and effective work relationships with coworkers, members, providers, and customers.
- Strong organizational and time-management skills, including the ability to manage simultaneous projects and tasks to meet internal deadlines.
- Strong verbal and written communication skills.
- Proficiency with Microsoft Office suite and applicable software programs.
Nice To Haves
- Managed care payor experience, preferably with Medicare/Medicaid government-sponsored programs.
- Understanding of ICD-9/10CM and MS-, AP-, and APR-DRG reimbursement.
- Electronic medical record (EMR) and medical record repository experience.
Responsibilities
- Lead and manage day-to-day operations for assigned payment integrity programs, ensuring accuracy, timeliness, and adherence to policies and procedures.
- Hire, train, and develop staff responsible for inventory management, reporting, data integrity, and recovery performance.
- Implement and monitor quality assurance programs and performance metrics to meet recovery and cost-avoidance targets.
- Collaborate with internal departments, including Shared Services, to resolve system or process issues affecting payment accuracy.
- Review and refine workflows and standard operating procedures to improve efficiency, accuracy, and audit readiness.
- Facilitate meetings with vendors and internal partners to discuss production performance, operational barriers, and process-optimization opportunities.
- Analyze operational data to identify trends, evaluate recovery effectiveness, and propose actionable improvements.
- Support compliance with CMS and state regulations.
- Contribute to small- to mid-scale projects focused on process improvement, automation, and data accuracy.
- Promote accountability, continuous improvement, and professional development within the team.
Benefits
- Competitive benefits and compensation package.
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What This Job Offers
Job Type
Full-time
Career Level
Manager
Education Level
No Education Listed
