Payment Integrity Program Development Manager

United States

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Not SpecifiedCompensation

Expert & Leadership (9+ 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 understanding of U.S. healthcare, including medical claims, billing, and payment policies, is essential. Demonstrated experience in developing new cost-saving concepts and implementing operational processes, along with strong analytical and communication skills, is required. Familiarity with claims adjudication, revenue cycle management, and data querying tools like SQL are desired, as is a Certified Professional Coder (CPC) or similar certification.

Responsibilities

The Payment Integrity Program Development Manager will identify and research new medical cost savings opportunities, leveraging subject matter expertise in healthcare payment policies. This role involves designing and building operational workflows to implement new programs from the ground up, ensuring their effectiveness and sustainability. The manager will collaborate with internal teams to address payment inaccuracies, drive program success, and manage multiple projects from concept to full implementation.

Skills

Payment Integrity

Healthcare Payment Policies

Healthcare Practices

Cost Savings

Claim Accuracy

Workflow Design

Process Improvement

Root Cause Analysis

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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