Manager of Payment Integrity

Job Summary

A company is looking for a Manager, Payment Integrity - Readmissions.

Key Responsibilities

• Develop, implement, and manage strategic fraud, waste, and abuse activities
• Lead teams to investigate fraud, waste, and abuse referrals
• Prepare and present the FWA program to state/federal personnel as required

Required Qualifications, Training, and Education

• Bachelor's degree in Business, Healthcare, Criminal Justice, or related field, or equivalent experience
• 4+ years of experience in medical claim investigation, compliance, or fraud and abuse
• Thorough knowledge of medical terminology
• Experience in managed care and supervisory roles preferred
• Medical records or coding license preferred