Responsible for managing all aspects of the Payment Integrity Program, with specific expertise in healthcare payment and reimbursement. This role oversees staff and related activities to ensure savings opportunities are identified, executed, and reported in support of the organization's cost containment efforts related to medical claims payment.
Works with executive leadership to establish priorities, goals, and objectives for the Payment Integrity program. Partners with Medical Policy and Provider Relations teams to plan and execute program tactics, while supporting performance improvement across claims integrity initiatives.
Requirements & Qualifications
Qualifications
- Bachelor's degree or equivalent experience in Healthcare, Nursing, or Business
- 5+ years of relevant experience in healthcare claim auditing, medical coding, healthcare revenue cycle, or regulatory work (such as CMS or Medicaid)
- 5+ years of experience with provider payment methodologies and concepts, including DRGs, capitation, RBRVS payments, APC, and percent of charges
- 5+ years of experience with state and federal regulations related to healthcare billing and coding
- Experience with healthcare claims
- Direct experience in hospital or physician billing, or equivalent managed care payer experience preferred
- Experience working with government programs including Medicare, Medicaid, and FEHB preferred
- Preferred credentials include RHIT, RHIA, CCS, CCS-P, CPC, CPC-P, or CPC-H
Benefits & Perks
Benefits and perks
- Comprehensive benefits package
- On-demand pay program powered by Payactiv
- Discounts on restaurants, phone plans, spas, and more
- Optional identity theft protection, home insurance, and auto insurance
- Traditional and Roth retirement options with service contribution and match savings
- Eligibility for benefits is determined by employment type and status
Location
Michigan, US
Employment Type
Full-time
Experience Level
Manager
Remote work allowed
No
Posted
1 month ago
Browse More Jobs