A bit about us:
Were on a mission to change healthcare how its paid for, delivered, experienced. We want to put people center stage, not process or profit. We are guided by a deep belief that every person on Medicare should be treated like we would treat a member of our own family: with loving care and a profound commitment to their health and well-being.
Thats why were gathering a whole bunch of smart, big-hearted people to create a new kind of healthcare company one that combines compassion, health insurance, clinical care, and technology seamlessly.
"We want to partner with people we love for a cause we believe in. Life is short. Join us."
A bit more about this role:
At Devoted, we know that one of the most important ways we will build trust is by ensuring we pay claims accurately and on time. We also have a fiduciary responsibility to protect the Medicare Fund and this role will play an integral part in doing that. The Payment Integrity Program Manager will be primarily responsible for the management of the company's Audit Programs specific to medical claims. The role will analyze, report and monitor the recovery results and provide recommendations to leadership on systems and process opportunities to mitigate errors. The program manager will work with vendors and internal offshore staff to ensure compliance with state and federal requirements.
Responsibilities will include:
- Development, implementation, and management of the Payment Integrity program.
- Day-to-Day relationship owner of Payment Integrity vendors
- Oversight of program workflow processes, inventory and performance.
- Independent research of issues with effective investigation and resolution techniques.
- Root cause analysis to maximize opportunities to mitigate payment error.
- Build prospective and retrospective detection, investigation, recovery and avoidance programs in conjunction with the vendor
- Development and presentation of monthly metrics, status reports, and presentations for leadership
- Coaching and mentoring of audit and claims staff
Attributes to success:
- Ability to motivate staff at all levels
- A true operator who will roll up your sleeves and do whatever it takes to get the job done
- You have a bias towards action and execution, and a track record to support your ability to get things done
- Clear head for process
- You are passionate about process improvement and efficiency, and have an ability to predict and prevent bottlenecks
- You have stamina for tackling hard problems
- Experience working with complex data and implementing systems and workflows
- A creative thinker with a can-do attitude
- Strong communicator who can work with cross-functional stakeholders and drive alignment
Desired skills and experience:
- 5+ years in payment Integrity with a focus in 2 or more areas of Focus: Data Mining, DRG Validation, Clinical Audit, COB, Subrogation, FWA, or Prepay Review.
- 3-4 years experience with Medicare and/or Medicaid Programs
- Bachelors degree in business, management, health care administration or other related field or equivalent work experience required.
- Experience with data analysis techniques
- Track record of success developing and implementing systems and processes and setting and achieving ambitious targets
If you love running towards complex challenges and transforming them into solutions, if you want to make a potentially huge impact on many lives, and if you are looking for a disruptive startup with an inspiring and talented team, Devoted Health may be the place for you!
Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoteds Code of Conduct, our company values and the way we do business.
As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.