Director, Payment Integrity
CareOregon
full-time
Posted on:
Location Type: Remote
Location: Oregon • Washington • United States
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Job Level
Tech Stack
About the role
- Lead the execution of payment integrity strategy and activity across the organization
- Direct operational payment integrity activities in support of all lines of business
- Ensure compliance with Federal and state regulatory and contractual requirements
- Prepare and present audit results including root cause and trend analysis
- Establish business cadence to ensure targets are met and/or exceeded
- Develop payment integrity inventory tracking and staff forecasting tools
Requirements
- Minimum 10 years’ health operations experience
- Minimum 4 years’ experience in various functions of Payment Integrity (claims editing, enrollment, COB, overpayment identification, claims auditing, pharmacy, Fraud, Waste and Abuse, and health care subrogation/third party liability)
- Preferred minimum 4 years’ experience in a supervisory position
- Minimum 8 years’ experience in managed care or health insurance industry
- Coding certification
- Large scale project oversight experience
- Financial management experience
- Tableau or Power BI experience
Benefits
- Medical, dental, vision, life, AD&D, and disability insurance
- Health savings account
- Flexible spending account(s)
- Lifestyle spending account
- Employee assistance program
- Wellness program
- Discounts
- Multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.)
- Strong retirement plan with employer contributions
- PTO and Paid State Sick Time based on hours worked/scheduled hours
- Paid holidays
- Volunteer time
- Jury duty
- Bereavement leave
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
payment integrityclaims editingenrollmentCOBoverpayment identificationclaims auditingpharmacyFraud, Waste and Abusehealth care subrogationfinancial management
Soft Skills
leadershippresentation skillsanalytical skillsorganizational skillsstrategic planning
Certifications
coding certification