Senior Manager, Payment Integrity – Data Mining Programs

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

📋 Description

• Supervise and evaluate both internal and external cost recovery and cost containment initiatives in relation to project metrics and anticipated recovery and cost avoidance objectives for each Health Plan.

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

• Collaborate with health plans and national vendors to pinpoint and limit costs across various recovery categories.

• Formulate annual budgets and projected targets for each national vendor, aiding them in reaching their anticipated annual savings.

• Assess and refine current processes while introducing new cost-reduction strategies.

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

• Help health plans comprehend the rules, regulations, and processes surrounding cost recovery.

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

• Compile and deliver reporting packages to Senior Management regarding cost avoidance and cost recovery efforts.

• Carry out additional duties as required.

• Adhere to all applicable policies and standards.

⛳️ Requirements

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

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

• Preference for candidates with experience in auditing government programs and compliance monitoring.

• Project management experience is preferred.

• Must comply with all relevant policies and standards.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase options.

• Tuition reimbursement opportunities.

• Paid time off along with holidays.

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

• Additional incentives may be included in the overall compensation package.