5 years leadership experience in payment integrity
Manage external audit vendors and internal teams
Develop payment policy and edit configuration
The Director will lead the development and execution of strategies to optimize payment accuracy and expand the organization's audit capabilities for a $550+ million portfolio
Job Summary
The Director will lead the development and execution of strategies to optimize payment accuracy and expand the organization's audit capabilities for a $550+ million portfolio.
Point32Health is a leading not-for-profit health organization dedicated to delivering high-quality, affordable healthcare to nearly 2 million members.
The role offers a competitive total rewards package including medical, dental, vision coverage, retirement plans, and paid time off.
Matching Summary
The Director will lead the development and execution of strategies to optimize payment accuracy and expand the organization's audit capabilities for a $550+ million portfolio.
Salary
Base: $160,335.20 - $240,502.80; Bonus/Equity: Variable pay eligible; Benefits: Comprehensive total rewards package including medical, dental, vision, and retirement plans
Skills & Requirements
Must-have
5 years leadership experience in Payment Integrity
Manage external audit vendors and internal teams
Develop Payment Policy and Edit configuration
Analyze data trends for process improvements
Ensure compliance with Medicare and Medicaid regulations
Nice-to-have
Strong subject matter expertise in healthcare laws
Experience managing high volume transaction environments
Excellent communication and negotiation skills
Knowledge of provider reimbursement methodologies
Ability to collaborate cross-functionally within company
Key Requirements
Bachelor's degree in Healthcare or Business Administration
Master's degree preferred
3-5 years health insurance claim management experience
Knowledge of Medicare and Medicaid Regulations preferred