Senior Manager, Payment Integrity Governance
About The Position
Oversee and monitor the performance of both internal and external cost recovery and cost containment initiatives according to targeted project metrics and forecasted recovery and cost avoidance goals for each Health Plan. Manage internal and external vendors cost avoidance and cost recovery initiatives. Partner with health plans to identify and contain cost through collaboration with national vendors for each recovery category. Develop annual budget and projected target for each national vendor and assist them with achieving projected annual savings. Evaluate and streamline existing processes and implement new processes to reduce costs. Present trends and cost containment opportunities, recommend action plans, and assist with the implementation of those plans. Assist health plans in understanding the rules, regulations and processes around cost recovery. Monitor other departments’ performance and processes and evaluate for cost recovery. Compile and Present reporting packages for Senior Management on current cost avoidance and cost recovery initiatives.
Requirements
- Bachelor’s degree in Accounting, Finance, Healthcare Management, related field or equivalent experience
- 6+ years of data analysis, finance or accounting experience
Nice To Haves
- Experience with government programs auditing, and compliance monitoring programs
- Project management experience
Responsibilities
- Oversee and monitor the performance of both internal and external cost recovery and cost containment initiatives according to targeted project metrics and forecasted recovery and cost avoidance goals for each Health Plan
- Manage internal and external vendors cost avoidance and cost recovery initiatives
- Partner with health plans to identify and contain cost through collaboration with national vendors for each recovery category
- Develop annual budget and projected target for each national vendor and assist them with achieving projected annual savings
- Evaluate and streamline existing processes and implement new processes to reduce costs
- Present trends and cost containment opportunities, recommend action plans, and assist with the implementation of those plans
- Assist health plans in understanding the rules, regulations and processes around cost recovery
- Monitor other departments’ performance and processes and evaluate for cost recovery
- Compile and Present reporting packages for Senior Management on current cost avoidance and cost recovery initiatives
Benefits
- competitive pay
- health insurance
- 401K and stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- flexible approach to work with remote, hybrid, field or office work schedules
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Senior
Number of Employees
5,001-10,000 employees
