Senior Provider Audit Specialist
Capital Blue Cross
SQL
Program Development Manager, Payment Integrity
Devoted Health
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteSalary
💰 $95,000 - $120,000 per year
Job Level
Mid-LevelSenior
Tech Stack
SQL
About the role
- Identify and research new medical cost savings opportunities
- Develop innovative payment integrity concepts and programs
- Leverage subject matter expertise to research opportunities for cost savings and improved claim accuracy
- Design and build the operational workflows necessary to implement new programs from the ground up
- Bring new concepts to life as a hands-on operator by building workflows and processes to support them
- Work closely with a variety of internal teams to understand the root cause of payment inaccuracies and drive program success
- Effectively manage multiple projects and priorities, from initial concept to full implementation
Requirements
- Bachelor's degree
- Minimum of 4 years of relevant professional experience
- A proven subject matter expert in U.S. healthcare, with a strong understanding of medical claims, billing, and payment policies
- Demonstrated ability to develop new concepts and ideas for cost savings and process improvement
- A track record of designing and implementing new operational processes and workflows
- The ability to leverage analytical tools and data to research ideas and support new concepts
- Excellent verbal, written, and presentation skills for collaborating with and influencing stakeholders at all levels
- A strong understanding of claims adjudication and revenue cycle management (desired)
- Familiarity with data querying tools like SQL (desired)
- Certified Professional Coder (CPC) or similar certification (desired)
Benefits
- Employer sponsored health, dental and vision plan with low or no premium
- Generous paid time off
- $100 monthly mobile or internet stipend
- Stock options for all employees
- Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles
- Parental leave program
- 401K program
- And more....
ATS Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
medical claimsbillingpayment policiesoperational processesworkflowsanalytical toolsdata queryingSQLclaims adjudicationrevenue cycle management
Soft skills
project managementcollaborationcommunicationpresentation skillsinfluencing stakeholdersproblem-solvinginnovationconcept developmentprocess improvementprioritization
Certifications
Certified Professional Coder (CPC)
