Manager of Payment Integrity

A company is looking for a Manager, Payment Integrity Governance. Key Responsibilities Monitor business processes and systems to ensure integrity and compliance in billing and claims payment Lead teams of analysts to investigate fraud, waste, and abuse referrals Develop customized fraud plans and educational materials to meet contract and federal requirements Required Qualifications Bachelor's degree in Business, Healthcare, Criminal Justice, or a related field, or equivalent experience 4+ years of experience in medical claim investigation, compliance, or fraud and abuse Thorough knowledge of medical terminology Previous experience in a managed care environment and in a supervisory role preferred Knowledge of Microsoft Excel, medical coding, claims processing, and data mining preferred