Manager Program Integrity, Geisinger Health Plan (Eastern United States resident

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Job Overview

The position of Manager Program Integrity at Geisinger Health Plan is a full-time role specifically geared towards candidates residing in the Eastern United States. This role primarily focuses on the integrity and compliance aspects of the Program Integrity Department, ensuring the organization adheres to all federal and state regulations while maintaining the accuracy and integrity of auditing data. The role is positioned as a remote opportunity based in Pennsylvania, allowing candidates to work from the comfort of their homes.

Key Responsibilities

The Manager of Program Integrity is tasked with overseeing the day-to-day operations of the department, which includes a wide array of critical activities tailored to ensure compliance and operational efficiency. A detailed list of responsibilities includes:

• Guiding team members in developing, updating work plans, tasks, timelines, and reports.
• Negotiating settlements and managing vendor relationships that support major corporate business decisions.
• Compiling and presenting audit summaries in a professional format for appropriate internal or external entities.
• Prioritizing and managing numerous audits to achieve financial savings and overpayment recoveries.
• Conducting regular compliance and performance reviews of auditor activities to uphold high standards.
• Participating in and coordinating the Provider Appeals process relevant to overpayment issues.
• Designing and implementing comprehensive programs across the organization in response to changes in managed care.
• Meeting tight deadlines and time-sensitive requests in an organized manner.

In essence, the manager also acts as an expert resource for any compliance-related questions tied to auditing and monitoring activities.

Required Skills

To effectively execute the responsibilities outlined for this role, candidates must possess several essential skills:

• Analytical Thinking: Capability to assess situations and make informed decisions based on data analysis.
• Communication Skills: Proficiency in both verbal and written communication is vital for expressing complex information understandably.
• Computer Proficiency: Knowledge of computer coding and software used in the health care and insurance sectors.
• Critical Thinking: Ability to analyze problems critically and utilize logical methods to resolve them.
• Fraud Detection and Management: Familiarity with techniques for identifying and managing fraudulent activities within the healthcare system.
• Leadership Skills: Experience in guiding teams and fostering an environment of collaboration and cooperation.

Educational Requirements

The educational background for candidates requires:

• High School Diploma or Equivalent (GED) at a minimum.
• For anyone who aspires to work in managerial or supervisory roles, possession of a Bachelor’s Degree is preferred, leading to a combination of related work experience amounting to 7 years. Alternatively, an Associate's Degree can count for up to 2 years of experience.

Experience Needed

Candidates must meet both of the following experience requirements:

• Minimum of 2 years in a managerial/supervisory role.
• Minimum of 7 years of relevant experience in areas related to compliance, auditing, or program integrity practices.

Company Culture and Values

Geisinger's culture is deeply rooted in caring for their patients, members, students, and communities. The core values they emphasize include:

• Kindness: Striving to treat everyone as they themselves would wish to be treated.
• Excellence: Continual pursuit of excellence in everyday work and collaboration.
• Learning: Commitment to sharing knowledge to foster growth and better prepare for future challenges in care.
• Innovation: Constant search for improved methods of delivering care.
• Safety: Assurance of a safe environment for all.

Additionally, Geisinger places a high significance on diversity, believing that it enriches the workplace and improves overall health outcomes.

Compensation and Benefits

While the specific salary details were not provided within the job summary, applicants can expect comprehensive healthcare benefits from day one, which include vision, dental, and coverage for domestic partners. Benefits and working conditions are designed to promote collaborative and collegial atmospheres, making Geisinger a conducive workplace for professionals in the health management field.

Equal Opportunity Employer

Geisinger is committed to being an affirmative action and equal opportunity employer. They are dedicated to fostering a workplace that provides fair consideration for employment to all qualified applicants, regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

This role represents an impactful leadership position that not only requires qualified candidates but also offers rewarding opportunities to influence the integrity of health plan operations in a rapidly evolving healthcare landscape.

This job offer was originally published on himalayas.app