Overseeing payment integrity programs (claims audits, pre-pay edits, vendor products, etc.)
Directing and leading payment integrity teams analyzing all evidence that provider payments are appropriate and accurately reflect billing / coding standards
Identifying opportunities for fraud, waste or abuse control and prevention
Researching healthcare related questions to support business areas and investigations
Maintaining and building relationships with external payment integrity vendors and senior management

Bachelors degree in business, healthcare or relevant field or equivalent work experience required
10 years
Experience in the health care industry required
5 years
Experience in a leadership/management role required
1 year
Experience with data analytics required
1 year
Auditing or other relevant experience required
1 year
Claims or operations experience preferred
Proficient in Microsoft Office suite including Microsoft Teams

Director, Claims Payment Integrity

Key skills