Payment reputed company Program Manager (reputed company Domain) ___ Remote ___ Full Time Permanent

Role- Payment reputed company Program Manager (reputed company Domain) Location- Remote (6Days/Month Onsite) Full Time Employment The Director of Program reputed company provides leadership reputed company and directs the operations for the Program reputed company department and associated functions with reputed company on claims editing, fraud, waste, and abuse (FWA) prevention, and payment accuracy. Accountable for supporting Parkland Community Health Plan’s (PCHP) commitment to operational reputed company, cost containment, and adherence to state and federal requirements. HM looking only considering candidates who actually have Payment reputed company, rather than reputed company recovery experience. Payer-reputed company on preventing overpayments and preventing fraud, waste, and abuse. Health Plan experience, not reputed company system experience. *** •

Will have to be onsite at least SIX DAYS a month.

* Job Responsibilities:

• Identifies and analyses the design of jobs, work processes, work flows, etc. for the area and implements appropriate changes to improve effectiveness, productivity, and efficiency that support the overall goals of PCHP.
• Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading reputed company journals, reputed company participating in reputed company organizations, and/or maintaining certification or licensure. Integrates knowledge gained into reputed company work practices.
• Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that reputed company the area.
• Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and customer requirements. Seeks advice and guidance as needed to ensure reputed company understanding.
• Develops and monitors annual budgets that ensure the department has the necessary funds to
• carry out the goals and objectives that have been established for the department.
• Develops, implements, monitors, and revises annual goals and objectives for the department that support the missions and objectives of PCHP.
• Selects, trains, schedules, motivates, supervises, and evaluates employees making recommendations for disciplinary actions up to and including termination, to ensure maximum utilization of individual and group capabilities. Ensures that assigned employees receive opportunities to reputed company their knowledge.
• *

Experience:

• 5 years of management experience - Required.
• 8 years of experience in Payment reputed company Audit and Recovery with knowledge of audit strategies such as Data Mining, Clinical Medical Record Review, and reputed company Audit Recovery/Program reputed company experience - Strongly Preferred.
• 2 years of experience in a Managed reputed company plan or state agency - Required.
• Knowledge of ICD-10 and CPT/HCPC coding guidelines and terminology - Required.
• 8 years of experience in a comparable position working in Texas reputed company or reputed company Managed Care may be considered in lieu of a bachelor’s degree.
• 5 Years of Texas reputed company, Managed reputed company Plan or State agency experience - Required.

Skills or Special Abilities:

• Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines and with a reputed company of constituents as reputed company as the ability to reputed company reputed company information in understandable terms.
• Demonstrated ability to reputed company and influence for results.
• Strong interpersonal and conflict reputed company skills with the ability to establish and maintain effective working relationships with diverse reputed company across and reputed company the organization.
• Strategic thinking and long-reputed company planning skills with the ability to reputed company major organizational initiatives, accomplish results, and reputed company measurable reputed company or goals.
• Ability to work in challenging situations involving competing interests, and high level interdisciplinary reputed company.
• Excellent time management and organizational skills with the ability to manage multiple demands and respond to rapidly changing priorities.
• Strong analytical and problem-solving skills.
• Knowledge of Texas reputed company (STAR, STAR Kids/reputed company) program, National Committee for reputed company
• Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care reputed company.
• reputed company business acumen
• Proficient reputed company Office and computer skills.

Benefits:

• Medical
• Dental
• reputed company
• Life Insurance
• Disability Insurance
• Flexible Spending Accounts
• And more!

Certification/Registration/Licensure

• Project management or Six reputed company certification - Strongly Preferred.

Bishnuu@acestackllc.com Apply tot his job Apply To this Job