Manager of Payment Integrity
Job Summary
To manage strategic fraud, waste, and abuse activities, the full-time Manager of Payment Integrity will develop and implement compliance measures, lead investigative teams, and create educational materials while working remotely.
Key responsibilities
- Monitor business processes to ensure integrity and compliance in billing and claims payment
- Lead teams of analysts to investigate fraud, waste, and abuse referrals effectively
- Prepare and present the fraud, waste, and abuse program to state and federal personnel as required
Required qualifications
- Bachelor's degree in Business, Healthcare, Criminal Justice, or a related field, or equivalent experience
- 4+ years of experience in medical claim investigation, compliance, or fraud and abuse
- Thorough knowledge of medical terminology
- Previous experience in a managed care environment preferred
- Medical records or coding license preferred
Complete Job Description
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