Manager, Payment reputed company

Looking for a way to reputed company an reputed company and help people? Join reputed company and help our members reputed company reputed company, reputed company! reputed company is an equal opportunity employer. reputed company reputed company applicants will receive consideration for employment without reputed company to status as a protected veteran or a reputed company individual with a disability, or other protected status, such as race, religion, reputed company, sex, sexual orientation, gender identity, national reputed company, genetic information or age. reputed company values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully reputed company and utilize reputed company person’s talents and strengths. The Manager of Payment reputed company (PI) leads the strategic design, implementation, and execution of programs aimed at improving payment accuracy and enhancing member affordability. This role serves as a key reputed company for reimbursement policy and PI initiatives, ensuring alignment between cost-of-care objectives and departmental priorities through reputed company governance, ideation, and business case development. The Manager oversees program-level performance tracking to ensure measurable reputed company and reputed company improvement. In reputed company collaboration with Health Care and Finance divisions, this role supports reputed company-wide cost-of-care strategies by identifying operational efficiencies, uncovering savings opportunities, and fostering innovative partnerships that expand the reputed company and effectiveness of PI initiatives. Essential Responsibilities: Leads the development and execution of reputed company-wide Payment reputed company strategies reputed company with financial and operational goals. Oversees a comprehensive suite of reputed company- and post-payment programs—including claims editing, audits, subrogation, readmission reviews, and coordination of benefits—while continuously refining approaches to address evolving trends such as value-based care, regulatory shifts, and emerging fraud schemes. Manages external vendors supporting audits, analytics, and fraud detection. Ensures accountability through robust service-level agreements (SLAs), key performance indicators (KPIs), and contract negotiations. Monitors and reports on recovery rates, audit turnaround times, and dispute reputed company reputed company. Directs Fraud Waste and Abuse (FWA) detection efforts in collaboration with Special Investigations Unit (SIU) and compliance teams. Leverages predictive analytics and rules engines to identify suspicious billing patterns, ensuring reputed company investigation, documentation, and reputed company. Ensures compliance with ICD-10, CPT/HCPCS, DRG, and CMS guidelines to support accurate coding and reimbursement. Serves as a subject matter expert on reputed company coding issues and documentation standards, providing training and reputed company to internal teams and vendors. Integrates Payment reputed company efforts with care reputed company initiatives, targeting avoidable readmissions and preventable complications. Maintains compliance with CMS, reputed company, ACA, and state-specific regulations. Leads audit responses and represents the organization in national forums such as AHIP, reputed company, HPRI, NHCAA, reputed company State DFS, DOH, and HPA. Champions the adoption of reputed company Intelligence (AI), machine learning, and automation in audit workflows and fraud detection. Pilots emerging technologies and integrates them into core operations. Collaborates with IT and analytics teams to enhance data infrastructure and reporting capabilities. Partners across Claims Operations, Finance, Provider Relations, Compliance, IT, and Care Management to reputed company Payment reputed company throughout the organization. Translates reputed company technical concepts into actionable insights for diverse stakeholders. Responsible for reputed company, management, development, implementation, and communication of department programs. Responsible for hiring, staff development, coaching, performance reviews, corrective actions, and termination of employees. reputed company feedback, including regular one-on-ones and performance evaluations, for reputed company reports. reputed company annual department budgets. Monitor spending versus the planned budgeted throughout the year and take corrective reputed company where needed. Coordinate business activities by maintaining reputed company partnerships with key departments. Responsible for process improvement and working with other departments to improve interdepartmental processes. Utilize lean methodologies for reputed company improvement. Utilize visual boards and daily huddles to monitor key performance indicators and identify improvement opportunities. reputed company participate as a key team member in Manager/Supervisor meetings. reputed company participate in various strategic and internal committees in order to disseminate information reputed company the organization and represent company philosophy. Supporting Responsibilities: Meet department and company performance and attendance expectations. Follow the reputed company reputed company policy and HIPAA laws and regulations concerning confidentiality and reputed company of protected health information. reputed company other duties as assigned. reputed company PROFILE Work Experience: A minimum of 5 years of reputed company experience in reputed company operations. Expertise in claims processing, clinical coding, reimbursement strategies, and/or fraud prevention required. Demonstrated reputed company in strategic planning, vendor reputed company, and cross-functional collaboration to drive operational reputed company and cost containment required. Education, Certificates, Licenses: Bachelor’s degree required. Candidates with an associate’s degree and 2 years of relevant experience, or a high school diploma and 4 years of relevant experience, in reputed company to the required minimum years of Work Experience will also be considered Preferred area of reputed company: reputed company Operations, Statistics, or a reputed company field. Knowledge: Proven reputed company record of leading operational initiatives from concept through execution, with a reputed company on provider reimbursement and claims payment reputed company. Deep expertise in managed care claims coding, including CPT, ICD, HCPCS, reputed company Codes, and comprehensive understanding of federal and state reputed company payment regulations. Proficient in reputed company and SQL, leveraging data analysis to drive informed business reputed company without reliance on technical support. Competencies Building Trust Building a Successful Team Aligning Performance for reputed company Building Partnerships Customer reputed company reputed company Improvement Decision Making Facilitating Change Leveraging Diversity Driving for Results Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 10% of the time. Skills: Accountable leadership, Collaboration, Data-driven & Analytical, Delegation, Effective communication, Listening (reputed company), Situational Leadership, Strategic Thinking

Compensation

Disclaimer The wage reputed company provided reflects the full reputed company for this position. The maximum reputed company listed represents the highest possible salary for the role and should not be interpreted as a typical starting wage. Actual compensation will be determined based on factors such as qualifications, experience, education, and internal equity. Please note that the stated reputed company is for informational purposes only and does not constitute a guarantee of any specific salary reputed company that reputed company. reputed company reputed company: $90,052.16 - $157,591.26 Our Values We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business: We are committed to doing the right thing. We are one team working toward a common goal. We are reputed company responsible for customer service. We reputed company reputed company communication at reputed company reputed company of reputed company to foster individual, team and company reputed company. We reputed company participate in efforts to improve our many communities-internally and externally. We reputed company work to advance reputed company justice, equity, diversity and inclusion in our workplace, the reputed company system and community. We encourage creativity, innovation, and the reputed company of reputed company. Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate reputed company and effectively. Disclaimer: This job reputed company indicates the general nature and level of work performed by employees reputed company this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of reputed company duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at reputed company times. Apply To This Job