Associate, Operations – West Branch
Team Rubicon
Director of Claims Payment – Payment Integrity Operations
Gravie
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteSalary
💰 $118,275 - $197,125 per year
Job Level
Lead
About the role
- Maintain efficient and accurate processes for claims payments and payment integrity that meet Gravie’s obligations for payment timeliness.
- Implement processes, technologies and potentially vendor relationships to increase the timeliness and completeness of Gravie’s recoupment of balances owed by providers.
- Ensure the claims payment, payment integrity, and balance recoupment processes meet all regulatory standards and contractual requirements.
- Manage relationships with third-party vendors and partners, ensuring performance standards and contractual obligations are consistently met.
- Work closely with claims operations, optimization, clinical, and finance teams to implement innovative solutions and resolve complex issues.
- Implement and maintain robust risk management strategies to protect the organization from fraud and other risks.
- Lead, mentor, and develop a team, fostering a culture of accountability and continuous improvement.
Requirements
- Bachelor's degree or equivalent experience.
- 8+ years of experience in healthcare claims and payments.
- 3+ years of team management experience.
- Deep understanding of applicable regulatory requirements.
- Strong understanding of health insurance payment integrity best practices and industry standards in areas such as subrogation, coordination of benefits, data mining, credit balance recoupment, and fraud/waste/abuse detection.
- Ability to make strategic decisions, plans, and actions based on data.
- Proven leadership and management skills, with experience building and motivating teams.
- Strong analytical, problem-solving, and strategic planning skills.
- Excellent verbal and written communication and interpersonal skills.
- Demonstrated success getting results through collaboration
Benefits
- Health insurance
- Alternative medicine coverage
- Flexible PTO
- Up to 16 weeks paid parental leave
- Paid holidays
- 401k program
- Cell phone reimbursement
- Transportation perks
- Education reimbursement
- 1 week of paid paw-ternity leave
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
healthcare claimspayment integritysubrogationcoordination of benefitsdata miningcredit balance recoupmentfraud detectionwaste detectionabuse detectionrisk management
Soft skills
leadershipteam managementanalytical skillsproblem-solvingstrategic planningcommunication skillsinterpersonal skillscollaborationaccountabilitycontinuous improvement
Certifications
Bachelor's degree
