Payment Integrity Manager Kansas
Overview
Carelon Payment Integrity Manager - Kansas ensures accurate claims payments by managing a robust process for preventing detection and correction of billing errors. This role drives impact through stakeholder coordination and cross-functional collaboration. Responsibilities include handling Payment Integrity waivers and supporting project execution. What sets this position apart is its focus on compliance evaluation and fraud detection.
What You'll Do11
- 1Coordinate and respond to executive inquiries for timely communication
- 2Process and manage Payment Integrity waivers
- 3Prepare responses to Requests for Proposals across all lines of business
- 4Document process flows for clear communication
- 5Assist in preparing polished presentations
- 6Review and approve performance guarantees
- 7Participate in cross-functional teams for problem remediation
- 8Analyze monthly reports and develop project plans
- 9Develop processes to detect systemic operational inefficiencies
- 10Monitor compliance plan provisions and investigate unusual incidents
- 11Evaluate regulatory changes and their impact on claim errors
Requirements5
- 1BA/BS in business engineering nursing finance healthcare administration with 5+ years related experience including 2+ years leadership
- 22-5 years Fraud Waste and Abuse experience
- 3Experience with payment integrity systems
- 4Familiarity with claims systems and GBD Facets
- 5Minimum 5 years related work experience
Salary Insight
Salary not disclosed in listing
Location
Required Skills
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