Payment Integrity Business Partner II

This is a fully remote position, open to applicants in Florida, +4 more states.

📋 Description

• Act as the main liaison for designated health plans, markets, and stakeholders concerning Payment Integrity programs, initiatives, and resolution of issues.

• Establish and nurture working relationships with market leadership, providers, vendors, and internal business associates.

• Represent Payment Integrity in various meetings, workgroups, governance forums, and strategic initiatives.

• Convey program performance, savings opportunities, operational impacts, trends, and updates on policies.

• Assist in the implementation of Payment Integrity initiatives and coordinate activities among operational, clinical, coding, analytics, compliance, regulatory, and vendor teams.

• Oversee assigned vendor relationships and track their performance.

• Aid in initiatives aimed at enhancing revenue and improving operations.

• Help resolve issues involving stakeholders, providers, regulatory bodies, vendors, and operations.

• Evaluate performance metrics and pinpoint opportunities to enhance payment accuracy, operational efficiency, and stakeholder satisfaction.

• Record decisions, themes, risks, and follow-up actions.

• Carry out additional responsibilities as assigned.

• Adhere to all organizational policies and standards.

⛳️ Requirements

• Must have authorization to work in the U.S. without requiring employment-based visa sponsorship at any time.

• Bachelor's degree and 2–4 years of relevant experience, or equivalent experience gained through applicable knowledge, duties, scope, and skills.

• At least 3 years of experience in healthcare operations, managed care, claims, payment integrity, provider relations, vendor management, or a related sector.

• Proven experience in collaborating with and influencing cross-functional teams and business stakeholders.

• Familiarity with presenting information, updates, and recommendations to leadership or business partners.

• Preferred experience in Payment Integrity, claims operations, healthcare reimbursement, Medicare, Medicaid, Marketplace, or managed care operations.

• Preferred experience in managing vendors, outsourced services, or external business partners.

• Background in supporting provider, regulatory, compliance, audit, or revenue-enhancement activities is preferred.

• Experience in interpreting operational, financial, or performance data is preferred.

• PMP and/or Lean Six Sigma certification, along with experience in project management, process improvement, or operational excellence, is strongly preferred.

🏝️ Benefits

• Competitive pay

• Health insurance

• 401K plan

• Stock purchase plans

• Tuition reimbursement

• Paid time off plus holidays

• Flexible work arrangements, including remote, hybrid, field, or office schedules

• Additional forms of incentives may be included in total compensation

• Equal opportunity employer committed to diversity