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Payment Integrity Program Manager Jobs in Florida

Cortina Solutions

Program Manager

Panama City, FL · On-site

Be a part of awinning team that provides technical solutions with integrity.Cortina is a government ... Beyond program management, we are seeking someone who can lead with influence. You must be ready to ...

SNC-Lavalin

Program Manager

Jacksonville, FL · On-site

$175K - $200K/yr

Manages programs aligned to business objectives for key clients. * Coordinates resources, budgets ... Rewards & benefits At Atkins Realis, our values-Safety, Integrity, Collaboration, Innovation, and ...

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Payment Integrity Program Manager information

What is the difference between Payment Integrity Program Manager vs Payment Recovery Specialist?

AspectPayment Integrity Program ManagerPayment Recovery Specialist
CredentialsTypically requires a bachelor’s degree in healthcare, finance, or related fields; certifications like CPC or CPAT are commonOften requires similar healthcare or finance background; certifications like CPC or CPT may be preferred
Work EnvironmentWorks within healthcare organizations or insurance companies, focusing on program oversight and complianceOperates in claims departments or recovery units, focusing on identifying and recovering overpayments
Employer & IndustryHealthcare payers, insurance companies, government programsInsurance companies, healthcare providers, third-party recovery firms

The Payment Integrity Program Manager oversees programs to prevent improper payments, ensuring compliance and efficiency. In contrast, the Payment Recovery Specialist focuses on identifying and recovering overpaid claims. While both roles require healthcare and finance knowledge, the Program Manager has broader responsibilities related to program management, whereas the Recovery Specialist concentrates on claims recovery activities.

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Payment Integrity Program Manager jobs near you
EMR Integrity Program Manager

EMR Integrity Program Manager

Halifax Health

Daytona Beach, FL • On-site

Full-time

Posted 11 days ago

Halifax Health rating

6.0

Company rating: 6.0 out of 10

Based on 66 frontline employees who took The Breakroom Quiz

748th of 890 rated healthcare providers

Job description

Day (United States of America)EMR Integrity Program ManagerThe EMR Integrity Program Manager oversees the accuracy, compliance, and quality of medical records to maintain patient information integrity. The manager will be responsible for identifying workflow improvements to maximize HIM related functions. This role will serve as a liaison across revenue cycle departments and applications. This position will serve as a liaison for Compliance to mitigate risk and optimize billing, coding, and business processes.
This role will be responsible to facilitate directors training initiatives across HIM.

  • 5 years experience in HIM, Compliance, or relevant field required

  • Bachelor's degree in HIM or related field required, Master's Degree preferred

  • CPC, CCS, or RHIA required

  • Preferred experience in EPIC's revenue cycle related applications

  • Ability to analyze, provide and execute operational insights

  • Advanced computer skills including but not limited to ability to create, analyze, assess, and report on data and trends

  • Strong verbal and written communication skills and proven ability to provide individual and group training

  • Ability to manage multiple projects with proactive follow-up

  • Ability to develop and execute actionable goals

DUTIES AND RESPONSIBILITIES:

  • Perform audits and investigations on revenue cycle errors and provides education

  • Oversees staff training schedules, job aids, compliance adherence, and post training competency evaluation as they relate to HIM and EMR

  • Responsible for ongoing training for compliance, regulatory, legal, and policy and procedure updates

  • Oversee projects for compliance to ensure EMR related activities are compliant with HIPAA, CMS and internal standards

  • Communicate investigation findings to management and facilitate change for HIM activities including medical record accuracy, diagnosis and CPT coding, and HIPAA compliance.

  • Monitor physician bell curve data and direct probe audits on outliers

  • Oversee projects for compliance to ensure EMR related activities are compliant with HIPAA, CMS and internal standards

  • Manage HIM contracted vendor access

  • Lead Revenue Integrity Committee, tracking OIG workplan and track accountability

  • Assess and identify gaps within HIM related revenue cycle workflows and develop/ facilitate action plans to improve processes

  • Identify opportunities for capturing additional revenue in accordance with payer guidelines

  • Work with hospital and outpatient-based departments to improve trends

  • Develop policies and/or guidelines to improve revenue integrity

  • Occasional travel to health system locations to provide support for onsite team members

  • Other duties as assigned

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