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:
...Description We're seeking an experienced Full-Stack Engineer to join our team working on a... ...You'll Work On Backend Services: Develop and maintain NestJS microservices handling... ...technical debt Experience mentoring junior developers (preferred) Package Manager...
...specializing in inference for AI generation (focus on AI Video). They have opened a requirement in San Francisco for a 1-2 day hybrid Research Engineer/Scientist. Role: Working with pretraining & optimizing models for video. Essential skills: BS & MS in...
...build a book of business and close high-value home improvement projects. This is a consultative, in-home sales role working directly with homeowners on window and door... ...plan. ~ Short-term/Long-term Disability Insurance - premiums are company paid. ~ Tuition Reimbursement...
...Circle Property Management is seeking a strong salesperson with a real estate background looking to join a great company. Your days... ...like Blue Circle Property Management. The Business Development Manager (BDM) at Blue Circle Property Management is responsible...
...patient-centered care. Role Description This is a full-time, on-site role located in West River, MD for a Physician with a specialty in Internal or Family Medicine. The Physician will provide comprehensive medical care and assist in overseeing clinical operations,...