Employer Industry: Healthcare Services
Why consider this job opportunity…
– Salary up to $190,400 annually
– Comprehensive benefits package including equity stock purchase and 401k contribution
– Opportunity for career advancement and growth within the organization
– Work remotely from anywhere within the U.S.
– Incentive and recognition programs available
– Supportive and inclusive company culture focused on health equity
What to Expect (Job Responsibilities):
– Coordinate with Market, Finance, Product, Medical Directors, and Healthcare Economics to identify and implement payment integrity opportunities
– Develop and implement payment integrity solutions through research and analysis of data and local business processes
– Lead program management for all California payment integrity services
– Create business cases to influence market partners and stakeholders for prioritizing new initiatives
– Ensure adherence to state and federal compliance policies and operational metrics
What is Required (Qualifications):
– 5+ years of experience in the healthcare industry
– 5+ years of experience working within MA, Medicaid and/or commercial lines of business
– Experience with product/vendor implementations and end-to-end process ownership for payment integrity programs
– Proficiency in Microsoft Office: Word, Excel, PowerPoint, and Visio
– Proven ability to manage competing priorities and engage with clients effectively
How to Stand Out (Preferred Qualifications):
– 1 or more of the following certifications: CPC, CPCO, AHFI, HCAFA, CFE
– Experience interpreting provider contractual agreements
– Experience managing a comprehensive portfolio of programs
– Proficiency in performing financial analysis/audit
– Comfortable with PMPM calculations and financial goal accountability
#HealthcareServices #RemoteWork #CareerGrowth #CompetitiveSalary #DiversityAndInclusion
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