[Remote] Payment Integrity and FWA Concept Development Lead at Devoted Health

United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Health Insurance, HealthcareIndustries

Requirements

Candidates must possess a Bachelor's degree and at least 4 years of relevant professional experience. A strong subject matter expertise in U.S. healthcare, including medical claims, billing, and payment policies, is required. Demonstrated ability to develop new concepts for cost savings and process improvement, along with a track record of designing and implementing new operational processes and workflows, is essential. The role also requires the ability to leverage analytical tools and data for research and concept support, as well as excellent verbal, written, and presentation skills for stakeholder collaboration and influence. Desired qualifications include a strong understanding of claims adjudication and revenue cycle management, familiarity with data querying tools like SQL, and a Certified Professional Coder (CPC) or similar certification.

Responsibilities

The Payment Integrity and FWA Concept Development Lead will develop innovative payment integrity concepts and programs, leveraging deep subject matter expertise to research opportunities for cost savings and improved claim accuracy. This role involves designing and building the operational workflows necessary to implement new programs from the ground up, ensuring their effectiveness and sustainability. The Lead will work closely with various internal teams to understand the root cause of payment inaccuracies and drive program success, while effectively managing multiple projects and priorities from initial concept to full implementation.

Skills

Payment Integrity

Healthcare Payment Policies

Medical Claims

Billing

Cost Savings

Process Improvement

Operational Workflows

Data Analysis

Project Management

Collaboration

Devoted Health

Medicare Advantage plans with personalized support

About Devoted Health

Devoted Health provides Medicare Advantage plans aimed at simplifying and making healthcare more affordable for seniors aged 65 and older. Their plans include services like provider and pharmacy searches, prescription drug coverage, and preventive care rewards. Members pay premiums for these plans, and the company may also receive government payments for managing Medicare benefits. What sets Devoted Health apart from competitors is their high level of customer service, featuring Devoted Health Guides who assist members in navigating their healthcare options and addressing common issues with traditional insurance. Additionally, they promote preventive care through the Devoted Dollars program, which rewards members for engaging in health activities. The goal of Devoted Health is to create a more compassionate and accessible healthcare experience for its members.

Waltham, MassachusettsHeadquarters

2017Year Founded

$2,194.5MTotal Funding

SERIES_ECompany Stage

HealthcareIndustries

1,001-5,000Employees

Benefits

Comprehensive health plan

401(k) retirement plan

Generous vacation and holiday time

Lyra mental health resources

Time off to vote

Risks

Increased competition from Medicare Advantage providers like Clover Health and Oscar Health.

Potential regulatory changes affecting Medicare Advantage plans by CMS.

Rising healthcare costs could impact the affordability of Devoted Health's plans.

Differentiation

Devoted Health offers personalized assistance through Devoted Health Guides for member support.

The company emphasizes preventive care with its Devoted Dollars rewards program.

Devoted Health integrates virtual and in-home care with top local providers.

Upsides

Devoted Health raised $287 million in Series E funding in 2024.

The company expanded Medicare Advantage plans to eight new states in 2023.

Devoted Health achieved a 5-star Medicare Advantage rating in Ohio in 2023.

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