Payment Integrity Manager
Job Summary
Managing strategic fraud, waste, and abuse activities, the full-time Payment Integrity Manager will develop and implement compliance measures while leading teams to investigate referrals and prepare reports, all in a remote work environment.
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 effectively
- Develop customized fraud plans and educational materials 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
- Medical records or coding license preferred
Complete Job Description
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