Senior Manager, Payment Integrity Program Development
Devoted Health
SQL
Payment Accuracy Recovery Analyst – Associate
Presbyterian Healthcare Services
full-time
Posted on:
Origin: • 🇺🇸 United States
Visit company websiteSalary
💰 $25 - $38 per hour
Job Level
JuniorMid-Level
Tech Stack
PHP
About the role
- Independent ownership and responsibility for payment accuracy financial recovery work to ensure accurate provider claims payment and support lowering the total cost of care for all lines of business - Medicaid, Medicare, Commercial and ASO.
- Manage post-payment reviews and audits to identify overpayments, duplicate claims, and billing anomalies securing financial recourse for the health plan.
- Manage multiple cross functional teams and vendors -SIU, external vendors and internal PHP teams to validate findings and initiate recovery actions with each independent agency.
- Leads audit and reviews on adjudication and coding errors to ensure on time and accurate payment.
- Own end to end executive level business process and data analysis across all provider reimbursement methods, influencing our partners by telling the right story with data.
- Own maintaining accurate claims payment to support the success of the ongoing payment accuracy identification and recovery for the health plan.
- Build, maintain, track and report recovery performance, ROI, and trends using dashboards and analytics tools.
- Accountable for strategic decision making to ensure accuracy, timeliness and clear communication of the payment accuracy recovery operation for the health plan.
- Lead prospective payment integrity efforts by identifying patterns and recommending edits or policy changes to prevent future errors and overpayments, reading out on trends to executive PHP leadership and developing mitigation strategies.
- Collaborate with finance, compliance, and provider relations to ensure accurate and timely resolution of recovery cases.
- Establish process for documentation and governance in accordance with regulatory and contractual requirements for payment accuracy of the health plan.
- Responsible for holding providers accountable through facilitating compliance with provider contracts.
- Point of contact for identifying and resolving outlier billing errors.
- Responsible for communication between PHP payment accuracy team and provider and partner business offices.
Requirements
- Associate degree in related technical/business; 3 years of additional experience can be substituted in lieu of degree.
- 6 months of Health Rules Payer specific experience.
- 6 months of Payment Integrity Vendor specific experience.
- Microsoft Office skills
- Knowledge of medical claims processing, coding - ICD, CPT, HCPCS, and reimbursement methodologies.
