Senior Manager, Payment Integrity – Vended Audit Programs

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

📋 Description

• Supervise and assess the effectiveness of both internal and external cost recovery and cost containment strategies 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 pinpoint and manage costs by working alongside national vendors for each recovery category.

• Create an annual budget and forecasted targets for each national vendor while supporting them in achieving their projected annual savings.

• Analyze and optimize existing processes and introduce new methods to lower costs.

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

• Assist health plans in navigating the regulations, rules, and processes related to cost recovery.

• Evaluate the performance and processes of other departments to identify potential for cost recovery.

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

⛳️ Requirements

• A 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 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-based schedules.