... and payment integrity functions. This role directs multiple operational teams and managers, ensuring the timely, accurate, and compliant processing of claims and premiums while maintaining the ...
Quick apply
... and payment integrity functions. This role directs multiple operational teams and managers, ensuring the timely, accurate, and compliant processing of claims and premiums while maintaining the ...
... and payment integrity functions. This role directs multiple operational teams and managers, ensuring the timely, accurate, and compliant processing of claims and premiums while maintaining the ...
... and payment integrity functions. This role directs multiple operational teams and managers, ensuring the timely, accurate, and compliant processing of claims and premiums while maintaining the ...
... and payment integrity functions. This role directs multiple operational teams and managers, ensuring the timely, accurate, and compliant processing of claims and premiums while maintaining the ...
... and payment integrity functions. This role directs multiple operational teams and managers, ensuring the timely, accurate, and compliant processing of claims and premiums while maintaining the ...
OPS Program Manager
Tallahassee, FL · On-site
$35/hr
CLASS TITLE: OPS PROGRAM MANAGER DIVISION: STATE FIRE MARSHAL BUREAU: FIRE PREVENTION CITY ... Review requisitions for payment to contracted services, and others furnishing services during ...
OPS Program Manager
Tallahassee, FL · On-site
$35/hr
CLASS TITLE: OPS PROGRAM MANAGER DIVISION: STATE FIRE MARSHAL BUREAU: FIRE PREVENTION CITY ... Review requisitions for payment to contracted services, and others furnishing services during ...
Lead Program Manager
Palm Bay, FL · On-site
... spend plans, payment forecasts, and variance reports. * Provide financial and programmatic ... Manage program-level changes and lead proposal development efforts for engineering change proposals ...
Lead Program Manager
Palm Bay, FL · On-site
... spend plans, payment forecasts, and variance reports. * Provide financial and programmatic ... Manage program-level changes and lead proposal development efforts for engineering change proposals ...
OPS Program Manager
Tallahassee, FL · On-site
$35/hr
CLASS TITLE: OPS PROGRAM MANAGER DIVISION: STATE FIRE MARSHAL BUREAU: FIRE PREVENTION CITY ... Supervise OPS Program team members. • Review requisitions for payment to contracted services, and ...
OPS Program Manager
Tallahassee, FL · On-site
$35/hr
CLASS TITLE: OPS PROGRAM MANAGER DIVISION: STATE FIRE MARSHAL BUREAU: FIRE PREVENTION CITY ... Supervise OPS Program team members. • Review requisitions for payment to contracted services, and ...
CLASS TITLE: OPS PROGRAM MANAGER DIVISION: STATE FIRE MARSHAL BUREAU: FIRE PREVENTION CITY ... Supervise OPS Program team members. • Review requisitions for payment to contracted services, and ...
CLASS TITLE: OPS PROGRAM MANAGER DIVISION: STATE FIRE MARSHAL BUREAU: FIRE PREVENTION CITY ... Supervise OPS Program team members. • Review requisitions for payment to contracted services, and ...
Program Manager - Manufacturing Job Category: Project and Program Management Time Type: Full time ... A culture of integrity. At CACI, we place character and innovation at the center of everything we ...
Program Manager - Manufacturing Job Category: Project and Program Management Time Type: Full time ... A culture of integrity. At CACI, we place character and innovation at the center of everything we ...
Expert Program Manager
Tampa, FL · On-site
At Prescient Edge , we believe that acting with integrity and serving our employees is the key to everyone's success. To that end, we provide employees with a best-in-class benefits package that ...
Expert Program Manager
Tampa, FL · On-site
At Prescient Edge , we believe that acting with integrity and serving our employees is the key to everyone's success. To that end, we provide employees with a best-in-class benefits package that ...
Manages special projects and initiatives related to provider reimbursement, payment integrity, and ... programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility ...
Manages special projects and initiatives related to provider reimbursement, payment integrity, and ... programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility ...
Manages special projects and initiatives related to provider reimbursement, payment integrity, and ... programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility ...
Manages special projects and initiatives related to provider reimbursement, payment integrity, and ... programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility ...
Provider Reimbursement & Prepay Editing Director
$102K - $169K/yr
Manages special projects and initiatives related to provider reimbursement, payment integrity, and ... programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility ...
Provider Reimbursement & Prepay Editing Director
$102K - $169K/yr
Manages special projects and initiatives related to provider reimbursement, payment integrity, and ... programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility ...
Manages special projects and initiatives related to provider reimbursement, payment integrity, and ... programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility ...
Manages special projects and initiatives related to provider reimbursement, payment integrity, and ... programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility ...
Program Manager SME
Orlando, FL · On-site
This Program Manager role will have program execution, capture, and proposal responsibilities. The ... integrity and corporate responsibility. If this sounds like a culture you connect with, you're ...
New
Program Manager SME
Orlando, FL · On-site
This Program Manager role will have program execution, capture, and proposal responsibilities. The ... integrity and corporate responsibility. If this sounds like a culture you connect with, you're ...
New
Provider Reimbursement & Prepay Editing Director
$102K - $169K/yr
Manages special projects and initiatives related to provider reimbursement, payment integrity, and ... programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility ...
Provider Reimbursement & Prepay Editing Director
$102K - $169K/yr
Manages special projects and initiatives related to provider reimbursement, payment integrity, and ... programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility ...
Sr. Program Manager
Miami, FL · On-site
$110K - $111K/yr
Maintain an integrated program plan across concurrent workstreams -- typically spanning core banking, digital channels, card management, compliance, payments, middleware architecture, and data ...
Quick apply
Sr. Program Manager
Miami, FL · On-site
$110K - $111K/yr
Maintain an integrated program plan across concurrent workstreams -- typically spanning core banking, digital channels, card management, compliance, payments, middleware architecture, and data ...
Lead Program Manager
Palm Bay, FL · On-site
... spend plans, payment forecasts, and variance reports. * Provide financial and programmatic ... Manage program-level changes and lead proposal development efforts for engineering change proposals ...
Lead Program Manager
Palm Bay, FL · On-site
... spend plans, payment forecasts, and variance reports. * Provide financial and programmatic ... Manage program-level changes and lead proposal development efforts for engineering change proposals ...
Provider Reimbursement & Prepay Editing Director
$102K - $169K/yr
Manages special projects and initiatives related to provider reimbursement, payment integrity, and ... programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility ...
Provider Reimbursement & Prepay Editing Director
$102K - $169K/yr
Manages special projects and initiatives related to provider reimbursement, payment integrity, and ... programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility ...
PCard Program Manager
Gainesville, FL · On-site
$70K - $80K/yr
... program integrity and drive efficiencies across UF's procurement processes. Key Duties ... Oversee payment to the bank and reconciliation of bank payments. * Manage compliance with PCard ...
PCard Program Manager
Gainesville, FL · On-site
$70K - $80K/yr
... program integrity and drive efficiencies across UF's procurement processes. Key Duties ... Oversee payment to the bank and reconciliation of bank payments. * Manage compliance with PCard ...
Assistant Program Manager
Saint Petersburg, FL · On-site
$45K - $50K/yr
... program integrity and high standards of care * Weekend leadership responsibilities are a key ... Experience managing shift coverage, staff task delegation, and weekend operations * Proven ability ...
Assistant Program Manager
Saint Petersburg, FL · On-site
$45K - $50K/yr
... program integrity and high standards of care * Weekend leadership responsibilities are a key ... Experience managing shift coverage, staff task delegation, and weekend operations * Proven ability ...
Payment Integrity Program Manager information
What is the difference between Payment Integrity Program Manager vs Payment Recovery Specialist?
| Aspect | Payment Integrity Program Manager | Payment Recovery Specialist |
|---|---|---|
| Credentials | Typically requires a bachelor’s degree in healthcare, finance, or related fields; certifications like CPC or CPAT are common | Often requires similar healthcare or finance background; certifications like CPC or CPT may be preferred |
| Work Environment | Works within healthcare organizations or insurance companies, focusing on program oversight and compliance | Operates in claims departments or recovery units, focusing on identifying and recovering overpayments |
| Employer & Industry | Healthcare payers, insurance companies, government programs | Insurance 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.
What are popular job titles related to Payment Integrity Program Manager jobs in Florida? For Payment Integrity Program Manager jobs in Florida, the most frequently searched job titles are:
What job categories do people searching Payment Integrity Program Manager jobs in Florida look for? The top searched job categories for Payment Integrity Program Manager jobs in Florida are:
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Job description
Location: Tallahassee, FL
Department: Claims
FLSA: Exempt
Schedule: As required
About the role:
We are seeking a Claims Operations Director to lead and oversee Capital Health Plan's end‑to‑end claims operations, including claims processing, other party liability (OPL) recoveries, premium billing and reconciliation, contract administration, and payment integrity functions.
This role directs multiple operational teams and managers, ensuring the timely, accurate, and compliant processing of claims and premiums while maintaining the integrity of provider records, contract configurations, and reimbursement systems. The Claims Operations Director partners closely with senior leadership, cross‑functional teams, and third‑party vendors to drive operational performance, regulatory compliance, system enhancements, and continuous improvement across all claims‑related functions.
We're looking for someone who has:
- Bachelor's degree from an accredited four-year college or university, or equivalent education and experience
- Significant leadership experience in claims operations, healthcare administration, or related functions; ten years of related experience preferred
- Demonstrated experience managing multi-disciplinary operational teams within a healthcare or payer environment
- Strong working knowledge of claims administration, premium billing, contract configuration, and payment integrity processes
- Ability to develop workflows, productivity standards, and performance metrics to meet operational and regulatory goals
- Strong analytical skills with experience using data to set KPIs and support senior leadership reporting
- Thorough understanding of healthcare billing and coding concepts (e.g., CPT, ICD, revenue codes)
- Strong written and verbal communication skills, including the ability to present complex operational information to senior leadership
Highly preferred candidates also have:
- Experience overseeing Medicare reimbursement processes and adapting to regulatory changes
- Experience with provider contract administration and system configuration management
- Experience managing software enhancements, reimbursement systems, or claims adjudication platforms
- Familiarity with provider billing operations and dispute resolution processes
- Strong financial acumen, including basic accounting knowledge and reconciliation concepts
- Experience leading cross-functional initiatives to improve claims, billing, or payment integrity outcomes
About Capital Health Plan (CHP):
CHP is a locally based, not‑for‑profit health maintenance organization serving the Tallahassee region for more than four decades. Founded by community leaders with a mission to deliver high‑quality, affordable, and patient‑centered health care, CHP has grown into a nationally recognized healthcare organization while remaining deeply rooted in the communities it serves.
CHP is proud to be an Equal Opportunity Employer and is committed to maintaining a workplace that values professionalism, integrity, and respect. We provide equal employment opportunities to all employees and applicants and do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other legally protected status.
Job Posted by ApplicantPro
About Capital Health Plan
Sourced by ZipRecruiter
In 1982, a group of Tallahassee’s civic leaders came together to create a quality, affordable health care system to meet the health needs of the community. Forty years later, Capital Health Plan has become a national health care leader. We started with 5,000 members and a network of 75 doctors. We’ve now grown to more than 135,000 members with a broad network of more doctors, hospitals and other health care providers throughout our service area. A key component of CHP’s delivery system is its employed medical staff, who practice in three state-of-the-art health centers CHP has developed to serve its membership. These health centers are equipped with electronic medical records and can accommodate a broad range of preventive, primary, and specialty care services including evening and weekend urgent care, lab, x-ray, digital mammography, ultrasound, colon screening, eye care services, wound care, and a center focused on the needs of chronically ill members. CHP’s ability to offer this highly organized component of its delivery system provides unique opportunities for adding value. The staff model of CHP’s delivery system is the engine of our program, consistently driving better results on measures of clinical care, member satisfaction, and affordability. As a not-for-profit HMO, we exist to improve the health of our communities by providing high quality, comprehensive health plans with low administrative costs, through primary care focused, patient-centered healthcare.
Industry
Health care and social assistance
Company size
201 - 500 Employees
Headquarters location
Tallahassee, FL, US
Year founded
1982