Manager - Payment Integrity Operations

Responsible for planning, organizing and managing an assigned business unit. Operate within broad objectives to ensure optimum utilization of resources; adapt business unit plans and priorities to address resource and operational challenges. Evaluate policies, procedures and business unit goals to make decisions and solve problems.

• Manage activities of a department including, but not limited to planning, problem solving, staff development and communication.
• Manage the evaluation of new and existing business processes to identify areas of opportunity and execute on business unit objectives, supporting continuous improvement.
• Lead, direct, evaluate and develop the work of assigned employees.
• Responsible for special projects, programs and initiatives to ensure successful delivery of business outcomes.
• Provide effective and efficient solutions to complex business problems
• Ensure that day to day business unit operations align with organizational objectives.

" Qualifications "

• Bachelor's Degree in a related field is required. Master's Degree in a related field is preferred.
• Five (5) years of experience in a related field is required.
• Previous experience leading projects and/or teams is required.
• Ability to effectively lead, coach and develop team members.
• Ability to work effectively in a team environment.
• Strong organizational, planning, analytical, and problem-solving skills.
• Working knowledge of corporate organizational structures, including functional responsibilities.
• Strong verbal, written communication and interpersonal skills.
• Ability to manage multiple priorities concurrently.
• Ability to solve practical problems and deal with moving variables in situations with limited standardization and alignment.
• Ability to interface and present to all levels of the organization.
Ability to build relationships and work collaboratively with cross-functional teams.

Departmental Preferences:

• Five (5) years related work experience in all lines of business, preferably in Claims Operations: Commercial PPO, HMO and Medicare product related work experience within a healthcare organization or equivalent combination of transferable experience and education is preferred.
• Seven (7) years Claim platform experience in Nasco-NPS and/or Facets is preferred.
• Demonstrated knowledge of Payment Integrity programs is preferred.
• Medical coding certification preferred is preferred.
• Extensive working knowledge and demonstrated subject matter expertise in the areas of Federal, State and BCBSA regulatory mandates and compliance programs is preferred,
• Ability to utilize functional and industry knowledge to efficiently and independently identify and build solutions for complex enterprise and product strategy issues related to Payment Integrity and Claims. is preferred

• Strong problem-solving and analytical skills as well as strong business acumen of healthcare claims with an emphasis on Payment Integrity is preferred.
  

All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability.