Payment Integrity Senior Manager

Job Summary

A company is looking for a Payment Integrity Program Development Senior Manager.

Key Responsibilities

• Identify and research new medical cost savings opportunities to improve claim payment accuracy
• Collaborate with internal teams to analyze claims payment inaccuracies and their impact on medical expenses
• Develop opportunity sizing models to estimate financial impact and prioritize concepts based on compliance risk and feasibility

Required Qualifications, Training, and Education

• Bachelor's degree and a minimum of 5 years of relevant experience in health plan analytics or payment integrity
• Strong command of claims data and healthcare reimbursement methodologies
• Proficiency in analytical and data mining tools for data analysis and root cause analysis
• Understanding of US healthcare regulations and practices
• Ability to translate complex data into actionable strategies for measurable savings