Manager Payment Integrity Position Available In Brevard, Florida
Tallo's Job Summary: This job listing in Brevard - FL has been recently added. Tallo will add a summary here for this job shortly.
Job Description
Manager Payment Integrity Health First Careers – 3.6
Melbourne, FL Job Details Full-time Estimated:
$68.6K – $89K a year 1 day ago Benefits Health insurance Qualifications Microsoft Excel Managed care ICD coding Microsoft Office 3 years
ICD-10 HCPCS
Analysis skills Project management Bachelor’s degree CPT coding Organizational skills Senior level Business Leadership Full Job Description Job Requirements
POSITION SUMMARY
Provide strategic leadership and management of the Health First Health Plans Operations, meeting the needs of internal customers and the requirements of the organization. Accountable and responsible for optimization of operational partner relationships which include managing programs, monitoring performance, tracking metrics and ensuring the claims operation process is compliant with operational and regulatory guidelines for the Plan.
PRIMARY ACCOUNTABILITIES 1.
Responsible for the coordination and oversight of all operational activities related to various claims processes. 2. Act as a technical expert in handling complaints and other escalated issues from internal and external customers. 3. Develop and execute audit/monitoring procedures to verify internal and external system controls for claims payment accuracy and assist with review, feedback, and resolution of potential inaccurate payments. 4. Collaborate and assist with Health Plan FDRs/Delegated Entities to maintain integrity through direct oversight in meeting regulatory and contractual requirements. 5. Work with interdepartmental and IDN leaders (as appropriate) to address top concerns, areas of risk, payment integrity, claims related regulatory changes, and their impact. 6. Establish and maintain key relationships with appropriate Health First and Health First Health Plan internal departments. 7. Manage state and federal reporting requirements, including routine and ad-hoc regulatory audit/monitoring preparation and participation as directed by HFHP Corporate Integrity. 8. Proactively plans for daily priorities as well as responds to new priorities within the organization and opportunities as assigned. 9. Responsible for compiling and submitting daily, weekly, and monthly departmental reports. 10. Responsible for developing and maintaining policies and procedures for the department.
LEADERSHIP ACCOUNTABILITIES 1.
Define and communicate a clear, compelling vision for the team that effectively ties into the mission and vision of Health First, and inspirationally leads the team to achieve that vision. 2. Provide leadership, motivation, coaching, feedback and support to strengthen growth, development and wellness at work to build and foster effective, high performing teams. 3. Lead change through effective communication, explaining the connection and value to the organization, creating stronger buy-in and urgency, while understanding impact to the team to obtain commitment. 4. Demonstrate openness to hearing diverse ideas and thoughts; create a sense of inclusivity; and encourage collaboration across teams to help break down silos to meet the team’s and organization’s goals. 5. Recruit, select, grow, and retain highly engaged, high performing diverse and inclusive associates. 6. Demonstrate fiscal acumen and contribute and support the strategic direction of the areas of responsibility and organization. Work Experience
MINIMUM QUALIFICATIONS
Education:
Bachelor’s degree in business, health care or related field.
Licensure:
None required
Certification:
No additional
Work Experience:
o Two years direct experience with management of healthcare claims, claims processing, claims editing, coordination of benefits, overpayment identification, claims auditing, appeals/grievances, subrogation, and fraud, waste and abuse. Work Experience in lieu of
Education:
Additional four years direct healthcare claims experience.
Knowledge/Skills/Abilities:
o Extensive knowledge of
CPT, HCPCS, ICD 10
codes sets and CMS billing guidelines. o Knowledge of managed care and insurance programs, provider payment structure, including CMS, Federal, State statutes and regulations. o Ability to research, analyze and communicate regulatory requirements. o Strong organization, project management, and analytical skills, with attention to detail. o Excellent oral, written and presentation skills. o Working knowledge of Microsoft Office, advanced Excel skills preferred.
PREFERRED QUALIFICATIONS
Education:
No additional
Certification:
No additional
Work Experience:
Three years direct healthcare claims leadership experience Benefits
ABOUT HEALTH FIRST
At Health First, diversity and inclusion are essential for our continued growth and evolution. Working together, we strive to build and nurture a culture that recognizes, encourages, and respects the diverse voices of our associates. We know through experience that different ideas, perspectives, and backgrounds create a stronger and more collaborative work environment that delivers better results. As an organization, it fuels our innovation and connects us closer to our associates, customers, and the communities we serve.
Schedule :
Full-Time
