Payment Integrity Manager
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About The Position
The Policy and Payment Integrity Manager oversees the PPI team and assists with implementation of policies to perform reviews conducted by CERIS including but not limited to itemized bill review, professional review, hospital outpatient and DRG validation. In this position, you will be managing members of the PPI team including developing team strengths and improving weaknesses, identifying team goals, and evaluating team progress. The manager in this role provides trend analysis of internal auditing of claims for claim accuracy related to pre and post payment claims, targeted claims, high dollar claims, and any other claim or record that requires quality review to determine the claim accuracy; assist with development of internal quality assurance measures based on client policy and industry guidelines; perform quality assurance reviews (as needed); assist in researching and implementing best practices related to payment policy, and/or policy initiatives; researching various healthcare policies; interpreting client, state, and CMS payment policies; assist in writing internal quality assurance policies; work with department managers in implementing payment policies and processes to meet quality assurance guidelines. This is a remote position.
