Sr Mgr Payment Integrity

The Senior Manager, Payment Integrity is responsible for the teams who focus on Prepayment and Post Payment reviews related to waste/error and primary and secondary editing vendors. The primary focus of these team members and vendors are to ensure appropriate provider claim payment. The position will include visibility to senior leadership through reporting of results and trending of findings and savings month over month. This position will be responsible for reverse engineering vendor savings, identifying medical cost leakage, share insight and absorb information that may lead to future findings and/or expansion opportunities. The duties of this position will have oversight and responsibility for communicating team results and working collaboratively to drive improvements through trending of pre-payment solutions, recoveries, the accuracy of claims payment, volume of claims adjustments, impact to provider service, degree of financial liability, and impact to provider billing pattern changes. In addition, this position will be responsible for new payment integrity related implementations are successful.

This is a working Manager position and may require the candidate to perform, review or summarize audits and includes training incoming staff on audit practices and procedures.

Key Performance Indicators: 1) Payment Waste and Errors initiative concept innovation 2) Support of Claim Cost Management Initiatives 3) Implementing strategies, with leadership, to achieve Medica's objectives in claims payment accuracy and prevention of Error and Waste overpayments; 4) Working with Director to escalate decision making around payment accuracy and Waste and Error strategy across multiple internal stakeholders; and 5) Executing on corrective action plans related to Errors and Abuse

Qualifications:

• Bachelor's degree, or equivalent working experience in health care
• Minimum of 10 years related work experience
• Minimum of 5 years leadership experience at a manager or higher level
• Minimum of 5 years of experience in vendor management
• 5 years of experience with claims recovery systems and tools

Skills and Abilities:

• Knowledge of medical coding
• Knowledge and understanding of healthcare products
• Understanding of provider contracting and claims processing
• Understanding of COSMOS, UNET, and healthrules capabilities preferred
• Process improvement experience preferred
• Presentation skills to broad audiences including senior and executive leadership
• Intermediate level of proficiency in MS Excel and MS Word

This position is a Hub role, which requires an employee to occasionally come onsite to the designated office, Minnetonka, for applicable heads-up work. Frequency is determined by business need as decided by leadership. OR This position is a Remote role. The employee must be located in any state in which Medica is an employer and will work remotely 100% of the time.

The full salary range for this position is $85,000 - $145,700. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to base compensation, this position may be eligible for incentive plan compensation in addition to base salary. Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

Medica's commitment to diversity, equity and inclusion (DEI) includes unifying our workforce through learning and development, recruitment and retention. We consistently communicate the importance of DEI, celebrate achievements, and seek out community partnerships and diverse suppliers that are representative of everyone in our community. We are developing sustainable programs and investing time, talent and resources to ensure that we are living our values. We are an Equal Opportunity/Affirmative Action employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.