Payment Integrity Program Development Manager

Position Overview

• Location Type:
• Job Type: Full time
• Salary: $95,000 - $116,000 annually

At Devoted Health, we’re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. We are building a new kind of all-in-one healthcare company, integrating compassion, health insurance, clinical care, service, and technology to deliver a complete and integrated healthcare solution. Founded in 2017, we serve members across the United States.

About the Role

The Payment Integrity Department ensures that provider claims are paid correctly, on time, and according to contractual terms, free of errors, duplicates, waste, or abuse. As a Payment Integrity Program Development Manager, you will identify and research new medical cost savings opportunities to improve claim payment accuracy and reduce overall medical spend. This involves assessing new opportunities by leveraging subject matter expertise, researching CMS policies and industry trends, analyzing Devoted claims performance, and collaborating cross-functionally.

Responsibilities

• Leverage subject matter expertise, policy research, industry trends, and internal/publicly available data to generate ideas.
• Collaborate with internal teams to identify claims payment inaccuracies, root causes, and their impact on medical expenses.
• Proactively and independently analyze medical cost trending, claim processing trends, overpayments, and other claim/medical expense irregularities to identify opportunities for cost reduction, improved claim adjudication accuracy, new payment policy changes, and new payment integrity programs.
• Independently create and iterate data sets to research ideas and develop data insights.

Requirements

• Bachelor's degree and a minimum of 4 years of relevant experience.
• Experience working in U.S. healthcare.
• Proficiency in a variety of analytical and data mining tools for idea generation, data analysis, and root cause analysis.
• Strong communication skills (verbal, written, presentation, interpersonal) for all types and levels of audience.
• Ability to multitask and effectively prioritize critical tasks and conflicting requirements.
• Ability to understand, explain, and break down complex problems.

Desired Skills and Experience

• Proficiency in performing data analysis and reporting using SQL queries and Google Sheets.
• Knowledge of claims adjudication and revenue cycle management.
• Experience with payment integrity concept ideation.
• Certified Professional Coder (CPC).

Compensation and Benefits

• Salary Range: $95,000 - $116,000 annually. The actual base salary offered will depend on various factors including qualifications, relevant experience, unique skills, education level, certifications, and location.
• Total Rewards Package:
  • Employer-sponsored health, dental, and vision plans with low or no premium.
  • Generous paid time off.
  • $100 monthly mobile or internet stipend.
  • Stock options for all employees.
  • Bonus eligibility for all roles.