Exec Dir, Payment Integrity & AIS Medical Expense Solutions

Job Summary:

The position is responsible for establishing and leading the National Payment Integrity Solutions shared service programs. To include:
Leading and managing National Claims Cost Containment/Payment Integrity programs, operations projects and initiatives to include (but not limited to) the following functional areas: COB/TPL/Work Comp cost avoidance and recovery; Code Editing technology strategy and rules management; Pre & Post Payment Audit/Claim review (including Clinical/Medical Audit); Internal and Vendor supported overpayment identification and Recovery processes (Collections, Credit Offset, Adjustment & Cash Posting); Data management and Decision Support reporting/analytic capabilities supporting both the Cost Containment/Payment Integrity functions as well as Regional/National leadership and financial planning functions; Operational Technology infrastructure and tools. Directing strategic planning for Cost Containment/Payment Integrity capability insuring a...