Payment Integrity Manager

Job Summary

A company is looking for a Sr. Manager Payment Integrity - Health Plan Concierge.

Key Responsibilities

• Provide operational and strategic leadership for Payment Integrity activities, ensuring alignment with enterprise goals
• Collaborate with various departments to address systemic issues, improve workflows, and enhance provider and member experience
• Direct provider education and communication efforts, ensuring clear messaging and successful adoption of initiatives

Required Qualifications

• Bachelor's degree in Healthcare Administration, Business, Public Health, or related field; Master's degree preferred
• 6+ years of experience in Payment Integrity, claims operations, or managed care operations
• 4+ years of leadership experience with direct reports
• Experience with PI functions such as audits and analytics
• Strong understanding of payment integrity concepts and regulatory requirements relevant to the line of business