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AVP, Payment Integrity
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- UPMC Health Plan is seeking an experienced, motivated, senior professional from the Healthcare Insurance space who is ready to take on an exciting, rewarding role at a market-leading, quickly growing Health Plan as an Associate Vice President (AVP) of Payment Integrity!
- The Associate Vice President (AVP), Payment Integrity reports to the Senior Vice President, Chief Risk, Compliance & Ethics Officer and strategically and operationally leads the development, implementation, and management of a robust and effective set of Fraud, Waste & Abuse (FWA) and Special Investigations Unit (SIU) for UPMC's large and growing Insurance Services Division.
- The role also reviews, tests, validates, and ensures that our payment integrity-related processes, controls, practices, and activities are soundly and effectively operating in a manner that strengthens and facilitates our business, financial and operational objectives.
- Develops annual FWA, Special Investigations Unit (SIU), clinical auditing, focused audit plans, based upon regular risk assessments and ongoing, data- and metrics-driven analyses, proactively identifying and utilizing the most recent and relevant industry/regulatory trends.
- This includes fraud detection software, data mining and analytics tools, subrogation vendors, and other such service providers.
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