Medical Director-Payment Integrity
HumanaSalary not specified
- Full Time
- Senior (5 to 8 years)
Not SpecifiedCompensation
Senior (5 to 8 years)Experience Level
Full TimeJob Type
UnknownVisa
Healthcare, Health Insurance, Medical ClaimsIndustries
Requirements
Candidates should possess a Bachelor’s degree and a minimum of 6 years of relevant experience in healthcare, demonstrating a strong understanding of US healthcare, claims adjudication, revenue cycle management, and payment integrity. They should be comfortable collaborating, communicating, and influencing across various departments, and possess the ability to thrive in both leadership and execution roles within an ambiguous and fast-paced startup environment. Incorporating company vision, mission, and values into decision-making is also required.
Responsibilities
The Senior Payment Integrity Manager will lead and optimize the execution of enterprise payment integrity initiatives, translating organizational strategy into operational action plans while ensuring alignment with savings goals, audit integrity, and regulatory compliance. This role will involve partnering with analytics, finance, compliance, and tech to identify new audit opportunities, improve processes, and develop scalable solutions, overseeing the health of audit pipelines, monitoring program KPIs, and utilizing data to identify root causes of inefficiencies. Furthermore, the manager will serve as a senior escalation point for complex issues, collaborate with departments such as Claims, Appeals, and Provider Relations, and implement improvements across the payment life cycle.
Skills
Claims Processing
Payment Integrity
Audit Programs
Operational Strategy
Regulatory Compliance
Cross-Functional Collaboration
Performance Optimization
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