Responsibilities
- Lead and manage the payment integrity and utilization management team.
- Develop and implement strategies to enhance payment integrity and utilization management processes.
- Collaborate with cross-functional teams to identify and address issues related to payment integrity and utilization management.
- Ensure compliance with regulatory requirements and industry standards.
- Analyze data to identify trends and areas for improvement in payment integrity and utilization management.
- Provide clinical expertise and guidance to support decision-making processes.
- Conduct peer reviews and audits to ensure appropriate utilization of healthcare services.
- Develop and deliver training programs to educate staff on payment integrity and utilization management best practices.
- Monitor and evaluate the effectiveness of payment integrity and utilization management programs.
- Work with stakeholders to develop and implement policies and procedures related to payment integrity and utilization management.
- Participate in the development and implementation of quality improvement initiatives.
- Collaborate with external partners to enhance payment integrity and utilization management processes.
- Provide clinical leadership and support to the payment integrity and utilization management team.
- Ensure accurate and timely documentation of payment integrity and utilization management activities.
- Conduct regular meetings with the team to discuss progress, challenges, and opportunities.
- Develop and maintain relationships with key stakeholders to support payment integrity and utilization management efforts.
- Identify and mitigate risks associated with payment integrity and utilization management processes.
- Provide input on the development of payment integrity and utilization management tools and technologies.
- Ensure that payment integrity and utilization management processes are aligned with organizational goals and objectives.
- Conduct regular reviews of payment integrity and utilization management data to identify trends and areas for improvement.
- Provide clinical expertise and guidance to support the development of payment integrity and utilization management programs.
- Collaborate with the legal and compliance team to ensure adherence to regulatory requirements.
- Develop and implement strategies to enhance the efficiency and effectiveness of payment integrity and utilization management processes.
- Ensure that payment integrity and utilization management processes are aligned with best practices and industry standards.
- Provide input on the development of payment integrity and utilization management policies and procedures.
Nice to Have
- Experience with Medicare and Medicaid programs.
- Familiarity with value-based care models.
- Experience with electronic health records (EHR) systems.
- Knowledge of healthcare analytics and data management.
- Experience with healthcare policy and regulation.
- Familiarity with healthcare reimbursement and payment systems.
- Experience with healthcare quality improvement initiatives.
- Knowledge of healthcare industry trends and best practices.
- Experience with healthcare data analysis and reporting tools.
- Familiarity with healthcare compliance and regulatory requirements.
- Experience with healthcare policy and procedure development.
- Knowledge of healthcare reimbursement and payment systems.
- Experience with healthcare quality and performance metrics.
- Familiarity with healthcare data management and analytics.
- Experience with healthcare policy and regulation.
- Knowledge of healthcare industry trends and best practices.
- Experience with healthcare data analysis and reporting tools.
- Familiarity with healthcare compliance and regulatory requirements.
- Experience with healthcare policy and procedure development.
- Knowledge of healthcare reimbursement and payment systems.
Compensation
Competitive salary and benefits package
Work Arrangement
Full-time, on-site
Team
Multidisciplinary team focused on payment integrity and utilization management
About Us
- We are a healthcare technology company focused on improving healthcare outcomes and reducing costs.
- We leverage data and analytics to drive innovation in healthcare delivery and payment systems.
- We are committed to providing high-quality, affordable healthcare to our members.
- We value diversity, inclusion, and collaboration in our workplace.
- We foster a culture of continuous learning and improvement.
- We prioritize the well-being and satisfaction of our members and employees.
- We strive to be a leader in healthcare innovation and technology.
- We are dedicated to making a positive impact on the healthcare industry.
- We believe in the power of data and analytics to transform healthcare.
- We are committed to providing exceptional customer service and support.
Our Benefits
- Comprehensive health, dental, and vision insurance
- 401(k) retirement savings plan with company match
- Generous paid time off and holidays
- Employee assistance program
- Tuition reimbursement and professional development opportunities
- Flexible spending accounts for healthcare and dependent care
- Employee referral bonus program
- Wellness programs and resources
- Employee recognition and rewards programs
- Professional liability insurance
- Life insurance and disability benefits
- Employee stock purchase plan
- On-site fitness center and wellness programs
- Employee resource groups and diversity initiatives
- Flexible work arrangements and remote work options
- Employee discount programs and perks
- Professional development and training opportunities
- Employee assistance and support programs
- Employee referral and recognition programs
- Employee wellness and fitness programs
- Employee resource groups and diversity initiatives
Not provided
