Senior Patient Accounting Specialist
INTEGRIS Health
Senior Manager, Payment Integrity Program Development
Devoted Health
full-time
Posted on:
Origin: • 🇺🇸 United States
Visit company websiteSalary
💰 $105,000 - $155,000 per year
Job Level
Senior
Tech Stack
SQL
About the role
- At Devoted Health, ensure provider claims are paid correctly, on time, and per contract to reduce waste and errors.
- Identify and research new medical cost savings opportunities to improve claim payment accuracy and reduce medical spend.
- Assess opportunities via policy research, industry trends, claims performance analysis, and cross-functional collaboration.
- Analyze medical cost trending, claim processing trends, overpayments, and other irregularities to develop payment integrity programs.
- Create and iterate datasets, develop data insights, and build opportunity sizing models to estimate financial impact and ROI.
- Partner with Clinical & Policy SMEs to validate findings against medical necessity and regulatory requirements.
- Maintain and prioritize a concept backlog; score and rank concepts using structured criteria.
- Monitor CMS updates, OIG/RAC findings, and industry trends to identify emerging risk areas and incorporate external benchmarks.
Requirements
- Bachelor's degree and a minimum of 5 years of relevant experience in health plan analytics, medical economics, or payment integrity.
- Demonstrated ability to translate complex data into actionable strategies that drive measurable savings.
- Strong command of claims data (facility, professional, pharmacy) and healthcare reimbursement methodologies (DRG, APC, CPT/HCPCS, NDC).
- Understanding of US healthcare
- Proficiency in a variety of analytical and data mining tools to generate ideas, analyze data sets, and perform root cause analysis
- Strong communications skills (verbal, written, presentation, interpersonal) with all types/levels of audience
- Ability to multitask and effectively prioritize critical tasks and conflicting requirements
- Ability to understand, explain, and break down complex problems
- Proficiency with SQL (desired)
- Knowledge of claims adjudication, revenue cycle management, and payment integrity (desired)
- Familiarity with CMS regulations and NCDs/LCDs (desired)
