Senior Manager, Payment Integrity – Governance

📋 Description

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

• Oversee cost avoidance and cost recovery initiatives with internal and external vendors.

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

• Create the annual budget and projected targets for each national vendor, supporting them in achieving their projected annual savings.

• Assess and enhance existing processes while establishing new methods to drive cost reductions.

• Analyze trends and opportunities for cost containment, propose action plans, and aid in the execution of those plans.

• Support health plans in comprehending the regulations, guidelines, and procedures related to cost recovery.

• Monitor the performance and procedures of other departments to evaluate cost recovery potential.

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

⛳️ 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.

• Preference for candidates with experience in 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 schedules.