Manager, Payment Integrity

Job Summary

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

Key Responsibilities

• Monitor business processes and systems to ensure integrity and compliance in billing and claims payment
• Lead teams of analysts to investigate fraud, waste, and abuse referrals
• Develop and implement customized fraud plans to meet contract and federal requirements

Required Qualifications

• 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
• Preferred experience in a managed care environment and as a lead or supervisor of staff
• Medical records or coding license preferred