Senior Manager, Payment Integrity

This is a fully remote position, open to applicants in Illinois, +3 more states.

📋 Description

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

• Oversee the cost avoidance and recovery efforts of internal and external vendors.

• Collaborate with health plans and national vendors to identify and manage costs for each recovery category.

• Create annual budgets and set projected targets for each national vendor, supporting the achievement of expected annual savings.

• Review and optimize current processes while implementing new strategies for cost reduction.

• Analyze trends and identify cost containment opportunities, propose action plans, and support their execution.

• Assist health plans in understanding the relevant rules, regulations, and processes pertaining to cost recovery.

• Evaluate the performance and processes of other departments with regard to cost recovery.

• Assemble and present reporting packages to Senior Management concerning cost avoidance and recovery initiatives.

• Carry out additional responsibilities as assigned.

• Adhere to all policies and standards.

⛳️ Requirements

• Bachelor's degree in Accounting, Finance, Healthcare Management, a related field, or equivalent experience.

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

• Preferred experience with auditing government programs and compliance monitoring.

• Project management experience is a plus.

• Capability to oversee initiatives related to cost recovery and cost containment.

• Proficiency in managing relationships with internal and external vendors.

• Understanding of the regulations and processes involved in cost recovery.

• Ability to formulate budgets, establish projected targets, and create reporting packages.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase options.

• Tuition reimbursement program.

• Paid time off in addition to holidays.

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

• Additional incentives may be included as part of the total compensation package.