Manager, Payment Integrity in Woburn, MA at Beacon Health Options

Date Posted: 10/18/2018

Job Snapshot

Job Description

About The Position:

The Payment Integrity Manager will join our team at our office in Woburn or Latham Service Center (preferred location), or Remote. The Payment Integrity Manager will be responsible for assisting the implementation of the Payment Integrity Center of Excellence and related activities under the direction of the AVP, Payment Integrity.

Position Responsibilities:

  • Assist Payment Integrity team, with meeting ongoing financial objectives for Beacon's negative balance, retro-eligibility and COB.
  • Assist Payment Integrity team with expanding the scope and processes of Payment Integrity Center of Excellence by facilitating awareness of coding and billing compliance
  • Manage vendor implementation and relationship
  • Develop project plans for various recovery opportunities with a focus on the financial impact generated by ongoing projects, vendor implementation and analysis activities
  • Develop policies and procedures and ensures compliance with government regulations
  • Works with other departments for solutions with external customers.
  • Serve in a variety of capacities in representing the department.
  • Develop and present ongoing provider trainings
  • Use existing claims platforms (FlexCare and Connects) to analyze claim recoupments
  • Support payment integrity team and assist with special projects by demonstrating flexibility with daily operations/functions

General Competencies:

  • Assist Payment Integrity team, with meeting ongoing financial objectives for Beacon's negative balance, retro-eligibility and COB.
  • Assist Payment Integrity team with expanding the scope and processes of Payment Integrity Center of Excellence by facilitating awareness of coding and billing compliance
  • Manage vendor implementation and relationship
  • Develop project plans for various recovery opportunities with a focus on the financial impact generated by ongoing projects, vendor implementation and analysis activities
  • Develop policies and procedures and ensures compliance with government regulations
  • Works with other departments for solutions with external customers.
  • Serve in a variety of capacities in representing the department.
  • Develop and present ongoing provider trainings
  • Use existing claims platforms (FlexCare and Connects) to analyze claim recoupments
  • Support payment integrity team and assist with special projects by demonstrating flexibility with daily operations/functions

Position Requirements:

  • Education: Bachelor’s Degree or related experience in lieu of a degree
  • Licenses: Certification in coding and/or auditing preferred

Relevant Work Experience:

  •  Healthcare experience required, managed care preferred 
  • Minimum 3-5 years of experience in payment integrity edits and activities, claims, claim edits, coding, and billing compliance.
  • Experience recovering overpaid Medicaid claims
  • 3 years managerial experience
  • Current or previous experience with Beacon's claims transactions systems highly desired. 

To Apply:

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Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment.  EOE/AA/M/F/Veterans/Disabled