Payment Integrity Manager

Job Summary

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

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 customized fraud plans to meet contract and federal requirements

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 and supervisory roles preferred
• Knowledge of Microsoft Excel, medical coding, claims processing, and data mining preferred