Senior Director Payment Integrity Edits

Job Summary

A company is hiring a Senior Director, Payment Integrity (Edits) to join their Payment Integrity team.

Responsibilities:

• Set, drive and execute on the pre-payment payment integrity strategy and vision to enhance the program's overall value, including determining and uncovering new opportunities
• Collaborate with Operations, Technology, and Network team leadership to identify and implement pre-payment editing performance strategies
• Manage payment integrity vendor relationships to build best in class program for editing and FWA

Qualifications:

• A bachelor's degree or commensurate 4 years of experience
• 15+ years experience in a cross-functional operations environment
• 3+ years of experience working at a health plan/payer
• Extensive knowledge of claims operations and processing, insurance products, contracts, and regulatory and policy language
• Experience analyzing and improving processes and workflows