Manager - Payment Integrity *Hybrid*
Description
Job Title: Manager – Payment Integrity
Department: Operations - Claims
Department: Operations - Claims
About the Role:
We are currently seeking a highly motivated Manager – Payment Integrity. This role will report to the Sr. Director – Operations - Claims and enable us to continue to scale in the healthcare industry.
What You'll Do:
- Work closely with outsourced payment integrity vendor to enhance our recovery efforts related to overpayments, duplicate payments, COB, Subrogation, and other areas.
- Determine additional payment integrity opportunities and work with internal teams and the vendor to implement.
- Develop clear reporting outputs to measure the efficacy of the payment integrity program.
- Drive continuous improvement efforts to improve claims quality and efficiency
- Resolve processing/system issues within assigned department
- Utilize claims management systems to provide reports and analysis to management on a regular basis
- Develop team members to ensure accountability for achievement of departmental goals and objectives
- Update and facilitate implementation of process and workflow modifications to improve operational efficiency
- Educate and train claims employees on the overall claims process and best practices for successful outcomes
- System updates maintaining the integrity of the Claims Payment Database; working inter-departmentally with other managers
- High level grievances or claim reconsideration request for reimbursable claim reviews
- Represent DMHC Regulatory and CMS Claims Payment Compliance issues at Management Meetings and with the Executive Board
- Responsible for other miscellaneous assignments as requested by Management
Qualifications:
- Minimum of a Bachelor's degree (B. A.) from a four-year college or university; or four (4) years current Management experience with an MSO or IPA Management
- Full knowledge of DMHC, DHS and CMS Regulations and Guidelines, ICD-9, CPT, RV/RBRVS codes
- Experience with contract law and Division Responsibility matrix interpretation
- Comprehensive knowledge in the AB1455 regulations
- EZ-CAP experience and knowledge required
Who We Are:
Astrana Health (NASDAQ: ASTH) is a physician-centric, technology-powered healthcare management company. We are building and operating a novel, integrated, value-based healthcare delivery platform to empower our physicians to provide the highest quality of end-to-end care for their patients in a cost-effective manner. Our mission is to combine our clinical experience, best-in-class delivery network, and technological expertise in order to improve patient outcomes, increase access to healthcare, and make the US healthcare system more efficient.
Our platform currently empowers over 10,000 physicians to provide care for over 1.9 million patients nationwide. Our rapid growth and unique position at the intersection of all major healthcare stakeholders (payer, provider, and patient) gives us an unparalleled opportunity to combine clinical and technological expertise in order to improve patient outcomes, increase access to quality healthcare, and reduce the waste in the US healthcare system.
Our Values:
- Put Patients First
- Empower Entrepreneurial Provider and Care Teams
- Operate with Integrity & Excellence
- Be Innovative
- Work As One Team
Environmental Job Requirements and Working Conditions:
- Our organization follows a hybrid work structure where the expectation is to work both in office and at home on a weekly basis. The office is located at 1600 Corporate Center Dr. Monterey Park, CA 91754.
- The total compensation target pay range for this role is between $90,000 - $125,000. This salary range represents our national target range for this role.
Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at [email protected] to request an accommodation.
Additional Information:
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.