Martin's Point Health Care
Healthcare Insurance • Wellness
Martin's Point Health Care is a healthcare organization committed to serving its local communities through high-quality primary and specialty care services. The organization places a strong emphasis on creating a positive workplace culture, recognizing employee contributions, and fostering workforce diversity. Martin's Point Health Care offers a range of career opportunities across various departments, from healthcare providers to corporate roles, and supports employee growth through competitive compensation, development programs, and generous perks. Additionally, the company is recognized for its community impact efforts, raising significant funds for community organizations and encouraging employee volunteerism.
Manager, Payment Integrity
Job not on LinkedIn
November 26
Martin's Point Health Care
Healthcare Insurance • Wellness
Martin's Point Health Care is a healthcare organization committed to serving its local communities through high-quality primary and specialty care services. The organization places a strong emphasis on creating a positive workplace culture, recognizing employee contributions, and fostering workforce diversity. Martin's Point Health Care offers a range of career opportunities across various departments, from healthcare providers to corporate roles, and supports employee growth through competitive compensation, development programs, and generous perks. Additionally, the company is recognized for its community impact efforts, raising significant funds for community organizations and encouraging employee volunteerism.
📋 Description
• Develop and oversee the organization’s payment integrity program aligns with industry standards, best practices, PI vendors to augment internal expertise and activities. • Lead pre-payment and post-payment audits to identify overpayments, duplicate claims, and inappropriate billing and coding to ensure recovery efforts are processed timely and accurately. • Utilize data analytics and reporting tools to identify trends, root causes, and process improvement opportunities related to claim inaccuracies. • Partner with Claims, Provider Relations, Finance, Compliance, and IT teams to improve claims processes, enhance automation, and ensure accuracy. • Manage relationships with external payment integrity vendors, including contract management, performance monitoring, and validation/reconciliation of results. • Ensure all payment integrity activities comply with Medicare and Tricare regulations, payer contracts, and internal policies. • Identify and implement best practices and system enhancements that improve the efficiency, accuracy, and integrity of payment integrity operations. • Prepare and present regular reports on all Payment Integrity initiatives/programs (internal and external) outcomes, savings, and performance metrics to senior leadership. • Establishes, monitors, and continuously improves processes and supporting policies and ensure PI team complies with all internal policies/procedures.
🎯 Requirements
• Bachelor’s degree in Finance, Business Administration, Healthcare Management or related field required • Professional certification (CPC, COC) required • 5 years management and/or leadership experience, with a focus on Payment Integrity, claims operations, healthcare auditing, or related roles. • Experience managing industry standard PI vendor partnerships and contract performance • Knowledge of claims policies and procedures, including industry standards from Medicaid, CMS, and CCI Edits • Understanding of or experience with fraud, waste, and abuse investigatory techniques and strategies • Solid understanding of standard claims processing systems, operations, and claims data analysis • Knowledge of HIPAA privacy regulation and rules necessary • Knowledge of CMS reimbursement methodology • Highly developed quantitative and qualitative analytical skills • Strong interpersonal skills, including professional communication, relationship building, and effective written and verbal communication • Proficiency with Microsoft Office Suite applications • Advanced skills in medical terminology, CPT/ICD-9/10 coding is preferred • Ability to articulate goals, plan and implement processes, and meet deadlines
🏖️ Benefits
• Health insurance • Professional development • Flexible working arrangements • Paid time off
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