Manager, Payment Integrity

This is a fully remote position, open to applicants in Virginia.

📋 Description

• Develops and implements work standards, quality measures, and process enhancements that align with the organization's objectives. Guarantees compliance with Medicare regulations, state authorities, Generally Accepted Accounting Principles, and other external governing bodies.

• Reviews claims to identify and rectify corrections or initiate resolutions, ensuring all follow-up claims and actions are submitted through the appropriate channels with all necessary attachments.

• Assesses the implications of new or upgraded systems/tools, conducts testing of system modifications, provides technical and operational support during implementation, and evaluates the effectiveness of new systems/tools.

• Guarantees timely and accurate billing, collection, posting, servicing, and auditing of the $1.5 billion receivables stream.

• Completes follow-ups using TRAC work lists, QMS, or other systems/reports in accordance with departmental policies, SRG guidelines, or industry best practices.

• Exhibits a strong understanding of CareMedic systems, DSS electronic billing systems, Syntellect IVR systems, HealthQuest 2000, QMS, and Premis electronic billing systems.

• Delivers feedback and training to supervisors and staff, ensuring timely resolution of pended (WIP backlog) claims as per defined timeframes and ensuring billed claims receive appropriate follow-ups based on established protocols or SRG.

• Manages the assigned department or functional area to ensure effective performance, which may involve hiring and training team members, creating and executing business strategies, managing team performance, and delegating tasks.

⛳️ Requirements

• Experience: A minimum of four years in Revenue Cycle, Clinic Operations, Credentialing, Denials Management, and/or HB/PB Operations roles; at least two years in leadership positions.

• Education: Bachelor’s degree or a lesser degree combined with four additional years of relevant experience.

• Advanced proficiency in Microsoft Excel (including advanced formulas, pivot tables, financial modeling, and dashboards).

• Demonstrated experience in financial analytics and reporting across various domains such as revenue cycle, accounts payable, and/or supply chain operations, including performance metrics (e.g., Net Revenue, AR, Denials, Cash, payment accuracy).

• Experience with payment processing, claims adjudication, accounts payable workflows, or supply chain financial operations, with a solid grasp of compliance and cost control.

• Expertise in process improvement, workflow optimization, and ensuring the accuracy, timeliness, and completeness of financial and operational data across functions.

• Excellent communication and presentation skills, with a track record of translating complex financial and operational data into actionable insights for leadership.

🏝️ Benefits

• Dedicated to Team Member Health: providing medical, dental, and vision coverage, along with a comprehensive wellness program for team members.

• Retirement: Inova matches the first 5% of eligible contributions starting from your first day.

• Tuition and Student Loan Assistance: offering up to $5,250 annually in educational assistance and up to $10,000 for student loans.

• Mental Health Support: providing all Inova team members, their spouses/partners, and children with 25 mental health coaching or therapy sessions, per person, per year, at no cost.

• Work/Life Balance: includes paid time off, paid parental leave, and flexible work schedules.