Program Manager, Health Plan Payment Integrity (Claims & Recovery)

📋 Description

• Lead and manage health plan payment integrity initiatives, providing subject matter expertise
• Own and execute scoreable action items (SAIs), ensuring performance targets, quality standards, and
• Oversee projects and activities that support CMS and state regulatory requirements for pre-payment
• Manage payment integrity inventory in collaboration with relevant teams to ensure recovery targets
• Drive improvements in claims payment accuracy, claim referrals, adjustment analysis, and financial
• Identify payment integrity issues, claims trends, and process gaps, and develop effective

🎯 Requirements

• At least 5 years of business analyst experience within a managed care organization (MCO), and at
• Demonstrated experience managing operational projects from initial concept through execution
• Strong understanding of managed care claims processing, reimbursement, and coding systems
• Knowledge of federal and state Medicaid payment regulations and requirements.
• Experience in payment integrity, cost management, claims recovery, or related healthcare claims
• Strong data analysis and querying capabilities, with the ability to interpret findings and use data

🎁 Benefits

• Annual salary range of $69,447 to $135,421, with actual compensation varying according to
• Full-time remote work arrangement.
• Competitive compensation and benefits package.
• Opportunity to contribute to initiatives that improve healthcare payment accuracy, operational
• Collaborative work environment involving cross-functional teams and health plan leadership.