Remote Director Payment Integrity

About

The Director of Payment Integrity is responsible for the Quality Assurance, Grievances & Appeals, and Fraud, Waste & Abuse teams.

Requirements

• B.S. degree or equivalent work experience in a healthcare operation
• 3-5 years experience in a managed care environment
• Strong understanding of federal and state regulations related to grievances and appeals
• Proficient in Excel
• Thorough understanding of medical and health plan terminology
• Excellent written and verbal communication skills
• Experience with SIHO systems including the HSP claims system
• Proficient in Microsoft Office suite

Responsibilities

• Directly supervise and manage the Quality Assurance, Grievances & Appeals, and Fraud, Waste & Abuse teams
• Read, research, and interpret federal and state regulations
• Continuously monitor and improve grievances and appeals processes
• Support the claims and benefit configuration quality assurance program
• Stay current on emerging fraud, waste, and abuse trends
• Analyze department and operational data in Excel
• Manage data transfers with vendor partners
• Develop, maintain, and report statistical measurements

Benefits

• 401(k)
• Distributed team
• Async
• Vision insurance
• Dental insurance
• Medical insurance
• Unlimited vacation
• Paid time off
• 4 day workweek
• 401k matching
• Company retreats
• Coworking budget
• Learning budget
• Free gym membership
• Mental wellness budget
• Home office budget
• Pay in crypto
• Pseudonymous
• Profit sharing
• Equity compensation
• No whiteboard interview
• No monitoring system
• No politics at work