Payment Integrity Manager

A company is looking for a Manager, Payment Integrity - Implementations. Key Responsibilities Develop, implement, and manage strategic fraud, waste, and abuse activities while ensuring compliance with state and federal requirements Lead teams of Project Managers to implement cost savings initiatives and coordinate health plan decisions Act as the primary point of contact for the Health Plan and facilitate Monthly Touchpoint Calls 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 4+ years of project management or account management experience in healthcare Thorough knowledge of medical terminology is required Payment Integrity experience and previous supervisory experience in a managed care environment are strongly preferred

Mar 26, 2025 - 14:20

A company is looking for a Manager, Payment Integrity - Implementations. Key Responsibilities Develop, implement, and manage strategic fraud, waste, and abuse activities while ensuring compliance with state and federal requirements Lead teams of Project Managers to implement cost savings initiatives and coordinate health plan decisions Act as the primary point of contact for the Health Plan and facilitate Monthly Touchpoint Calls 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 4+ years of project management or account management experience in healthcare Thorough knowledge of medical terminology is required Payment Integrity experience and previous supervisory experience in a managed care environment are strongly preferred