Mgr Payment Integrity

Related keywords: remote job project managerremote job in healthcarehealthcare remote job

Overview

The position discussed here is for a Manager of Payment Integrity at Blue Cross and Blue Shield of Nebraska (BCBSNE). This organization is dedicated to promoting the health and well-being of its members and communities, focusing on optimizing business processes and improving customer experiences. The Manager of Payment Integrity plays a crucial role in executing the organization’s compliance strategies, addressing payment integrity, and enhancing operational efficiency across various lines of business.

Role and Responsibilities

In this managerial role, the selected candidate will be responsible for overseeing the execution of the organization’s *payment integrity *strategies. The responsibilities include:

• Managing payment integrity activities concerning both business group and vendor oversight.

• Overseeing auditing programs to ensure vendor quality and compliance.

• Driving operational improvements across functional teams to enhance payment accuracy and efficiency.

• Facilitating detailed reporting on payment integrity activities, which involve pre and post-payment audits, recovery processes, Clinical Editing, and much more.

• Creating robust audit programs aimed at meeting corporate goals and addressing pain points effectively through collaboration with various teams.

• Reporting audit results, suggesting actionable recommendations, and developing ongoing status reports for the leadership.

• Partnering with technology providers to research and implement effective workflows that commit to ensuring payment integrity.

Candidate Requirements

To be eligible for this position, candidates must meet specific qualifications:

• A Bachelor's degree in Business, Healthcare Administration, or a related field is essential.

• A minimum of 5 years of experience in areas such as payment integrity, auditing, or healthcare operations is required.

  

• Candidates must demonstrate strong leadership and project management skills, showcasing expertise in audit methodologies and familiarity with regulatory compliance.

• Excellent analytical, communication, and problem-solving abilities are also crucial to enable effective team collaboration and relationship management.

• An equivalent combination of education and experience may be accepted.

• Candidates should be able to adhere to attendance and punctuality expectations.

• They must also be adept at working in a collaborative environment and maintaining positive relationships with both staff and clients.

Salary and Benefits

While specific salary information is not explicitly mentioned, BCBSNE provides competitive compensation relative to industry standards. Employees often receive additional benefits such as health insurance plans, retirement savings options, professional development opportunities, and potentially performance-based bonuses, although these specifics depend on internal policy.

Conclusion

This position presents a unique opportunity for professionals in the payment integrity space to influence and improve the operations of a mission-driven organization. The emphasis on diversity and inclusion indicates a supportive workplace culture, which allows individuals from various backgrounds to contribute meaningfully to the organization’s objectives. Blue Cross and Blue Shield of Nebraska’s commitment to setting strategic goals across business units allows for ample career development opportunities and the chance to make a significant impact in the healthcare industry.

This job offer was originally published on himalayas.app