Healthcare Payment Integrity Manager
Job Summary
Leading a team of healthcare payment integrity experts, the fully remote Manager, Payment Integrity Program Development & Innovation will develop, implement, and optimize complex audit programs aimed at identifying and recovering healthcare overpayments.
Key responsibilities
- Lead and mentor a team in the design and implementation of payment integrity audit programs
- Develop and maintain a portfolio of complex audit concepts while identifying emerging overpayment risks
- Collaborate with analytics and technology teams to design and optimize claim selection methodologies and audit algorithms
Required qualifications
- Bachelor's degree in Nursing, Health Information Management, Healthcare Administration, Business Administration, Finance, or a related field
- Minimum of 5 years of healthcare Payment Integrity experience
- Minimum of 3 years of leadership experience managing audit, coding, or payment integrity teams
- Demonstrated experience developing complex healthcare audit concepts and claim selection methodologies
- Strong knowledge of healthcare reimbursement methodologies and claims adjudication processes
Complete Job Description
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