Mgr Payment Integrity

Blue Cross and Blue Shield of Nebraska

11d

About The Position

At Blue Cross and Blue Shield of Nebraska, we are a mission-driven organization dedicated to championing the health and well-being of our members and the communities we serve. Our team is the power behind that promise. And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, there’s no greater time for forward-thinking professionals like you to join us in delivering on it! As a member of Team Blue, you’ll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community. The Manager of Payment Integrity is responsible for executing the organization’s payment integrity strategy across all lines of business. This role oversees audit programs for vendor quality and drives cross-functional operational improvements. The position ensures compliance, optimizes processes, and supports strategic initiatives to enhance payment accuracy and efficiency.

Requirements

Bachelor’s degree in Business, Healthcare Administration, or related field
Minimum 5 years of experience in payment integrity, audit, or healthcare operations.
Strong leadership and project management skills.
Expertise in audit methodologies, vendor oversight, and regulatory compliance.
Excellent analytical, communication, and problem-solving abilities.
An equivalent combination of education and experience may be substituted for this requirement.
The ability to meet or exceed the attendance and timeliness requirements of their departments.
The ability to work well in a team environment and be capable of building and maintaining positive relationships with other staff, departments, and customers.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Other duties may be assigned.

Responsibilities

Manage the execution of payment integrity activities across the organization, focusing on business group and vendor oversight, operational planning, resource allocation, and team management.
Provide input into enterprise-wide strategic plans.
Facilitate the coordination of reporting for payment integrity activities, including post- and pre-payment audits, recovery processes, COB, Subrogation, clinical editing, and medical chart reviews.
Develop and maintain a robust payment integrity operation and vendor audit program to meet corporate and strategic goals.
Present audit results, including root cause analysis and trend reporting, and prepare remediation recommendations on a scheduled basis.
Create ongoing status reports detailing actions, outcomes, and program metrics.
Partner with teams to address pain points and improve performance.
Research and implement effective technologies, workflows, and sourcing partnerships to achieve payment integrity commitments.
Manage Payment Integrity projects from initiation through completion, ensuring alignment with organizational objectives.
Establish and maintain departmental policies, procedures, and workflows to support compliance and operational excellence.