Senior Manager Payment Integrity - SCAN Temp

SCAN Health Insurance•Long Beach, CA

1d•$51 - $74•Remote

About The Position

The Senior Manager Payment Integrity - SCAN Temp manages a cross-functional system configuration team that supports various departments within SCAN, including Enrollment, Billing, Authorizations, Claims, Encounters, Member Services, Finance, Provider Data, Network Management, and IT. This role collaborates closely with Business, IT, and vendors to achieve desired outcomes. Key responsibilities include overseeing system configuration, system implementations, issue triage, issue tracking, defect remediation, adherence to change control procedures, and system testing. The position also involves implementing procedures to optimize system capabilities and data integrity.

Requirements

Bachelor's Degree or equivalent experience required.
10-12 years of related experience with a health plan, healthcare, or related industry.
5-8 years of leadership experience.
IKA and/or QNXT System experience is required.
Knowledge of HIPAA regulations and privacy laws required.
Healthcare payment integrity experience.
Comprehensive knowledge of the field's concepts and principles.
Performs complex tasks typically following established processes.
Leads and directs the work of other employees and has full authority for personnel decisions.
Primarily focused on administering established policies and procedures but may have some impact on departmental budgeting, strategic planning, and procedural change.
Leadership - Lead and inspire teams to achieve performance goals, offering guidance and support.
Problem Solving - Strong problem solving skills.
Communication - Strong written and verbal communication and interpersonal skills.
Strong presentation skills to effectively address diverse audiences.
Advanced Microsoft Office skills (Word, Excel, PowerPoint, Outlook, Teams) required.
A background check is required.

Nice To Haves

Curious about AI and its power to transform how we operate and serve our members.

Responsibilities

Leads the coordination, validation, and implementation of new payment integrity vendors.
Develops and manages the maintenance approach to payment integrity tasks and change control procedures.
Manages cross-functional interaction with Business, IT, and within Business Shared Services regarding the development of payment integrity requirements, documentation, and implementations.
Manages response to day-to-day payment integrity related issues and issue logs, including escalated research issues and coordination of appeals with the Audit and Review team.
Supports other Business Shared Services departments as needed.
Partners with IT Help Desk to support payment integrity related issue intake and resolution.
Partners with IT to support and perform release management activities.
Develops and maintains a library of existing and retired configuration rules, including the source of the rule, implementation/retirement dates (by State and Line of Business), and other configuration-related decisions (e.g., provider exclusions).
Documents supporting authority for configuration rules.
Researches and recommends modifications to current policies and procedures.
Prepares reports by collecting, analyzing, and summarizing information and trends.
Attends various committee meetings regarding regulatory requirements, compliance, member and provider issues, and strategic planning.
Accomplishes staff results by communicating job expectations; planning, monitoring, and appraising job results; coaching, counseling, and disciplining employees; initiating, coordinating, and enforcing systems, policies, and procedures.
Maintains staff by recruiting, selecting, orienting, and training employees; maintaining a safe and secure work environment; developing personal growth opportunities.
Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies.
Actively support the achievement of SCAN’s Vision and Goals.
Other duties as assigned.