Senior Manager Payment Integrity

JOB REQUIREMENTS: Description The Senior Manager, Payment Integrity isresponsible for the teams who focus on Prepayment and Post Paymentreviews related to waste/error and primary and secondary editingvendors. The primary focus of these team members and vendors are toensure appropriate provider claim payment. The position will includevisibility to senior leadership through reporting of results andtrending of findings and savings month over month. This position will beresponsible for reverse engineering vendor savings, identifying medicalcost leakage, share insight and absorb information that may lead tofuture findings and/or expansion opportunities. The duties of thisposition will have oversight and responsibility for communicating teamresults and working collaboratively to drive improvements throughtrending of pre-payment solutions, recoveries, the accuracy of claimspayment, volume of claims adjustments, impact to provider service,degree of financial liability, and impact to provider billing patternchanges. In addition, this position will be responsible for new paymentintegrity related implementations are successful. Performs other dutiesas assigned. This is a working Manager position and may require thecandidate to perform, review or summarize audits and includes trainingincoming staff on audit practices and procedures. Key PerformanceIndicators: 1) Payment Waste and Errors initiative concept innovation 2)Support of Claim Cost Management Initiatives 3) Implementing strategies,with leadership, to achieve Medica's objectives in claims paymentaccuracy and prevention of Error and Waste overpayments; 4) Working withDirector to escalate decision making around payment accuracy and Wasteand Error strategy across multiple internal stakeholders; and 5)Executing on corrective action plans related to Errors and Abuse KeyAccountabilities: Department Management Development, monitoring andreporting of goals and metrics for waste and error reviews andeffectiveness. Achievement of department production goals Generalmanagement duties (coaching, team, staff and 1:1 meetings, issueidentification, escalation and resolution, performance measurementDepartment recruitment, selection, retention and performance improvementin coordination with department director Perform annual performancereviews Develop and maintain staff morale and promote teamwork. Providerecognition to staff through the reward and recognition programs Coach,encourage and facilitate individual growth and development throughspecific, timely and consistent feedback Provide technical support tostaff by assisting them timely. Guide them to other appropriateresources, if needed. Ensure they receive the training needed to helpthem be successful in their daily roles as well as provide themopportunities for growth Collaborate with the team to create... Forfull info follow application link. Equal Opportunity Employer includingVeterans and Disabled Individuals APPLICATION INSTRUCTIONS:Apply Online: ipc.us/t/808CDC1B90A2424D

Created: 2025-10-04