Supervisor of Payment Integrity

Network Health is seeking a Supervisor of Payment Integrity. This role provides leadership support to strengthen and sustain payment integrity efforts at Network Health by providing guidance, coordination and oversight of the team activities. The supervisor oversees the collection, reporting and analysis of data associated with claims and enrollment audit review activities, fraud waste and abuse special investigations and assures that findings are communicated with the appropriate business areas and that corrective action plans are implemented where necessary.

• →Assumes responsibility for personnel related duties including interviewing, disciplinary actions, payroll and enforcing required rules and regulations, consulting with the director, as necessary
• →Responsible for accurate, timely and efficient review of scheduled audits
• →Oversee fraud, waste and abuse special investigations and communicate with appropriate departments any findings and action steps
• →Oversee payment accuracy and quality assurance audits and reviews, and communicate with appropriate departments any findings and action steps
• →Partners with other departments to identify, develop and implement new audit algorithms to improve payment accuracy
• →Provide support and leadership to department through regular team meetings, one-on-one, and interim and annual performance review discussions
• →Conducts all hiring, training, and time and performance management for the team. Consults with leader and Human Resources as necessary
• →Participates in problem solving and prioritizing review activities and oversees the completion and reporting of review activities for service level agreements and communicating results with leadership
• →Provides leadership and evaluation of the team to help ensure productivity and continuous process improvement
• →Responsible for the development and maintenance of a reporting dashboard that outlines the progress and status of all audits as well as their outcomes
• →Oversees and assists with the development of audit policies and procedures

• Bachelor’s degree or equivalent years of equivalent work experience required
• 3 or more years health care or health insurance experience is required
• 2 or more years working in a quality assurance or auditing role required
• 1+ years’ experience in leadership or mentoring required
• Knowledge of health care industry practices and key health care compliance concepts
• Ability to motivate and guide a team to reach established goals
• Effectively communicate and report team performance results in a clear and concise format

Network Health is an Equal Opportunity Employer.