Healthcare Payment Integrity Manager

Healthcare Payment Integrity Manager

Our client is a high-growth, venture-backed startup, dedicated to revolutionizing the U.S. healthcare system. They encourage collaboration among individuals with diverse backgrounds and ideologies to drive innovation. If you're passionate about leveraging cutting-edge technologies to make a significant impact on U.S. healthcare, we invite you to join this company’s mission-driven team.

As a Healthcare Payment Integrity Manager, your primary functions will be to refine and optimize medical billing reviews through meticulous examination and analysis. This entails scrutinizing medical bills, patient records, and audit findings to enhance the efficiency of our AI-driven review system. Your responsibilities will encompass pinpointing discrepancies in billing and coding, validating charges against medical documentation, and confirming the fidelity of billed services against healthcare plan remittances.

This Role Offers:

• Medical, Dental, and Vision benefits
• Flexible, paid vacation policy
• Work in a flat organizational structure with direct access to leadership.

Focus:

• Leading and nurturing a team dedicated to the integrity of payment analyses, ensuring their work meets the highest standards of accuracy and efficiency.
• Evaluating team output, offering regular performance feedback, and encouraging ongoing excellence and operational improvement.
• Developing and updating procedural guides for a broad spectrum of claim evaluations to ensure consistency and compliance with industry benchmarks.
• Fostering collaboration across departments to refine and advance payment integrity workflows and methodologies.
• Providing comprehensive training and educational resources to team members, ensuring alignment with regulatory standards and practices.
• Executing audits and quality control assessments to confirm the reliability of billing analyses.
• Serving as a primary resource for expertise on reimbursement models and coding standards, offering guidance across the organization.

Skill Set:

• Itemized Bill Review Experience Required
• Active clinical licensure within the U.S. (RN, APRN, or above), with essential certifications in CPC or CCS; CPMA certification is highly valued.
• A decade of healthcare industry experience, with a significant portion in a clinical capacity and at least five years in a leadership role with direct oversight responsibilities.
• Adept in analytical thinking and problem-solving, with a deep understanding of healthcare reimbursement systems and coding protocols.
• Strong communication skills, proficiency in negotiation, and a meticulous attention to detail.
• Competency in utilizing healthcare technology platforms, with an eagerness to learn and adapt to new digital tools.

About Blue Signal:

Blue Signal is a leading executive search firm specializing in healthcare recruiting. Our healthcare recruiters have expertise in placing high-performing talent in healthcare IT, medical devices, biotechnology, pharmaceuticals, etc. Learn more at bit.ly/3G5DbWr