- Detroit, Michigan, United States
- Manager
- 5+ years
Responsibilities
- Provides subject matter expertise for oversight, production, and resolution of health plan payment integrity recovery concepts
- Executes and monitors health plan scoreable action items to ensure performance and quality levels exist in PI Business products and processes
- Establishes procedures and techniques to achieve operational goals and executes tasks and projects to ensure CMS and state regulatory requirements are met for pre-pay edits and overpayment recovery
- Manages inventory and works in collaboration with PI team to ensure SAI targets are met
- Makes independent and informed decisions that contribute to health plan strategy and acts as a trusted voice in resolving complex business challenges
Requirements
- Nice to have: experience with Medicare, Medicaid, and/or Marketplace lines of business
- Nice to have: Certified Business Analysis Professional (CBAP)
- Nice to have: Certified Coding Specialist (CCS)
- Nice to have: project management experience
- Nice to have: familiarity with Medicaid-specific scorable action items (SAIs)