Senior Manager, Payment Integrity

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

📋 Description

• Supervise and assess the effectiveness of both internal and external cost recovery and cost containment initiatives in alignment with targeted project metrics and projected recovery and cost avoidance objectives for each Health Plan.

• Oversee cost avoidance and cost recovery initiatives led by internal and external vendors.

• Collaborate with health plans to identify and manage costs by working closely with national vendors across various recovery categories.

• Create the annual budget and set projected targets for each national vendor, assisting them in achieving the expected annual savings.

• Assess and refine existing processes while implementing new strategies to lower costs.

• Provide insights on trends and cost containment opportunities, propose action plans, and support the execution of those strategies.

• Aid health plans in comprehending the regulations, guidelines, and procedures associated with cost recovery.

• Evaluate the performance and processes of other departments concerning cost recovery.

• Compile and present comprehensive reporting packages to Senior Management regarding current initiatives for cost avoidance and cost recovery.

⛳️ Requirements

• A Bachelor’s degree in Accounting, Finance, Healthcare Management, a related field, or an equivalent level of experience.

• A minimum of 6 years of experience in data analysis, finance, or accounting.

• Preferred experience with auditing government programs and compliance monitoring programs.

• Project management experience is preferred.

🏝️ Benefits

• Competitive pay.

• Health insurance.

• 401K and stock purchase plans.

• Tuition reimbursement.

• Paid time off plus holidays.

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