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:
...Team and Make a Difference! Are you passionate about creating a clean and welcoming environment? We're seeking a diligent Housekeeping Director with exceptional cleanliness standards to oversee and maintain the cleanliness of all areas within our facilities. As an essential...
...ensure the safety of children at all times Be alert to the needs of children as individuals and as a group Work with the teaching team to set up and maintain the classroom Maintain punctual and consistent attendance Communicate frequently with parents...
...Insight Global is seeking a Sterile Processing Technician to support a healthcare customer in Annapolis, MD. This individual will be responsible for assembly and sterilization of all instruments, instrument trays, utensils, and linen packs. They will also perform distribution...
...Duration: 6 months contract Job Summary: Nurse Practitioners will work in collaboration with a dedicated clinical care team to provide evidenced-based care to a panel of patients. The clinical care team will work with the provider daily to drive better outcomes for...
...typography, and motion skills with acute attention to detail. Digital Graphic Designer Responsibilities: Translate creative concepts with elevated design for digital platforms including but not limited to social media, email marketing, ecomm, boutique and OOH...