The Senior Manager leads critical components of the enterprise Payment Integrity program to prevent inappropriate payments and ensure accurate financial outcomes
Job Summary
The Senior Manager leads critical components of the enterprise Payment Integrity program to prevent inappropriate payments and ensure accurate financial outcomes.
This role manages multi-functional teams responsible for prospective edit development, clinical reviews, retrospective audits, and recovery operations across all lines of business.
The position requires translating regulatory updates and provider contract terms into systematic accuracy improvements while ensuring programs are audit-ready and compliant.
Matching Summary
The Senior Manager leads critical components of the enterprise Payment Integrity program to prevent inappropriate payments and ensure accurate financial outcomes.
Salary
Base: $117,509.00 - $188,015.00; Bonus/Equity: Not specified; Benefits: Not specified
Skills & Requirements
Must-have
6 years Payment Integrity experience
5 years staff management experience
Medicaid Medicare Commercial managed care
Pre-pay and post-payment review expertise
Provider contract interpretation skills
CPT HCPCS ICD-10 coding knowledge
Overpayment recovery operations
Nice-to-have
Predictive analytics application
SQL and BI tools proficiency
Algorithm-based PI solutions
Vendor program management
Root cause evaluation expertise
Cross-functional stakeholder collaboration
Key Requirements
Bachelor's degree required; Master's preferred
Minimum 6 years in Payment Integrity or related field
Minimum 5 years leading and supervising staff
Experience with COB and Third-Party Liability claims
Knowledge of Division of Financial Responsibility (DOFR)