director healthcare reimbursement strategy - Sterling Heights - beBeePaymentIntegrity

    beBeePaymentIntegrity
    beBeePaymentIntegrity Sterling Heights

    1 day ago

    Job title: Program Manager, Health Plan Payment Integrity

    Description

    Health Plan Payment Integrity Specialist

    As a Health Plan Payment Integrity Specialist, you will play a vital role in ensuring the accuracy and integrity of health plan payments. Your expertise will be essential in overseeing production and resolution of health plan payment integrity (PI) recovery concepts.

    The position requires strong analytical skills to execute and monitor scoreable action items (SAIs) that ensure performance and quality levels exist in PI Business products and processes. You will establish procedures and techniques to achieve operational goals while executing tasks and projects to meet Centers for Medicare & Medicaid Services (CMS) regulatory requirements.

    Additionally, this role involves managing inventory collaboration with the PI team to ensure SAI targets are met. Independent decision-making is required as you contribute to health plan strategy while acting as a trusted voice resolving complex business challenges impacting cost-containment regulation compliance.




    Business Leadership & Operational Ownership,

    This includes independently owning scorable action items (SAIs), including assisting & executing project tasks to ensure CMS state regulatory requirements met pre-pay edits post-payment datamining overpayment recovery improve encounter submissions reduce general administrative expenses drive positive outcomes all payment integrity solutions-

    1- Independently leads efforts improve claim payment accuracy referrals adjustment analysis financial performance-

    2 - Collaborates with operational teams enterprise stakeholders finance partners proactively identify issues implement resolution strategies-

          Serve thought partner healthcare leadership provide well-reasoned recommendations support short long-term business goals,

        Partner network team communicate recovery projects provider relations informed respond inquiries-,
    3-) Apply understands lenses shape related recommendations plans created clear measurable workflows solutions-h /div>p ppolsupport reporting tiesoperationaloutcomesfinancial targets..


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