The Director of Claims Integrity and Analytics is responsible for leading the comprehensive management of claims payment processes, ensuring the accurate and timely execution of claims. This includes overseeing third-party administrator (TPA) performance, maintaining the integrity of payment configurations, and managing claims appeals. The position requires collaboration with internal teams and external partners to ensure that claims payments are processed in accordance with contractual agreements and regulatory requirements. The role will also focus on optimizing the medical payment process to reduce costs and improve outcomes, while ensuring compliance with applicable regulations to prevent fraud, waste, and abuse (FWA). A strong understanding of healthcare policies, payment methodologies, and advanced analytical skills are essential.
Key Responsibilities:
Claims Payment Integrity:
Claims Operations & Delegation Management:
Claims Appeals & Audits:
Management & Leadership:
Strategic Oversight & Continuous Improvement:
Qualifications:
Education:
Experience:
Other Skills:
...Palliative Care Physician _Pittsburgh-PA _Full-Time (FTE)_Direct Hire Position: Palliative Care Physician Job Type: Full-Time (FTE)... ...* Doctorate Degree in Medicine * Board Certified in Hospice and Palliative Medicine * Comfort and skill in advance care...
...communication and customer service skills Why Join Us? Gain valuable mentoring experience Build your resume with hands-on teaching opportunities Work in a flexible and supportive environment How to Apply: Please submit your resume via LinkedIn...
...here. The ability for you to make an impact in your community. The recognition you deserve for a job well done. Hair Stylist/Barber Qualifications: Cosmetology and/or Barber License. The passion to build genuine connections with customers and provide GREAT...
Position Summary: Provides general observational support for assigned patient care area. Works with other members of the patient care team to deliver care to patients in age groups including children, adolescents, adults, and geriatrics based on unit population....
...for effective provisioning, installation/configuration, operation and maintenance of systems hardware/software and related infrastructure. Act as Tier I and II support to end users on a daily basis when required. Responsible for first level day to day onsite support of...