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Payment Integrity Program Manager Jobs in New York

CVS Health

Program Integrity Manager

New York, NY

$54K - $145K/yr

Position Summary The Program Integrity Manager serves as a key leader supporting Medicaid Program Integrity, Payment Integrity, and Special Investigations Unit (SIU) activities. This role is ...

HIFI

Payments Program Manager

Manhattan, NY · On-site

Required : • 4+ years of program or operations management in card issuing, payments infrastructure, or an adjacent fintech domain. • Deep operational understanding of card network mechanics ...

HIFI

Payments Program Manager

New York, NY · On-site

$135K - $180K/yr

... payment experience, and owning the partnerships and unit economics of every program we run. If you ... Hands-on experience managing sponsor banks, processors, or networks directly -- you've run the QBRs ...

HIFI Bridge, Inc

Payments Program Manager

New York, NY · On-site

$135K - $180K/yr

... payment experience, and owning the partnerships and unit economics of every program we run. If you ... Hands-on experience managing sponsor banks, processors, or networks directly - you've run the QBRs ...

Haddad Brands

Product Integrity Manager

Manhattan, NY · On-site

$75K - $125K/yr

The Product Integrity Manager will ensure global execution of Haddad Brand's chemical management and product integrity program vision to meet and exceed the product safety & compliance expectations ...

Haddad Brands

Product Integrity Manager

Manhattan, NY · On-site

$75K - $125K/yr

The Product Integrity Manager will ensure global execution of Haddad Brand's chemical management and product integrity program vision to meet and exceed the product safety & compliance expectations ...

Wipro Limited

Head of TPA Operations

Avenel, NJ · On-site

Demonstrated experience managing payment integrity functions, including FWA programs. * Proven experience with provider data management processes within a TPA or health plan environment. * In-depth ...

Curtisswright

Program Manager

East Farmingdale, NY

$150K - $170K/yr

Program Manager We are looking for a Program Manager to join our Target Rock Team! As a Program ... fee payment, and therefore become the property of Curtiss-Wright. Compliance Statement This ...

Curtiss-Wright

Program Manager

East Farmingdale, NY · On-site

$150K - $170K/yr

Program Manager We are looking for a Program Manager to join our Target Rock Team! As a Program ... fee payment, and therefore become the property of Curtiss-Wright. Compliance Statement This ...

Stripe

Program Manager

New York, NY · Remote

$148K - $210K/yr

Run incubation and governance programs for payments and banking products (Stripe Managed Payments ... Stripe Capital, fiat-to-crypto onramp/Payin integrations), guiding features from private beta to ...

Stripe

Program Manager

New York, NY · On-site

$148K - $210K/yr

Run incubation and governance programs for payments and banking products (Stripe Managed Payments ... Stripe Capital, fiat-to-crypto onramp/Payin integrations), guiding features from private beta to ...

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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

Senior Analyst, Vendor Payment Integrity - Remote

EmblemHealth

New York, NY • On-site, Remote

$68K - $118K/yr

Full-time

Re-posted 27 days ago

EmblemHealth rating

9.4

Company rating: 9.4 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

7th of 303 rated insurance

Job description

Summary of Job
Review vendor trends and impact on care cost, member and provider experience. Perform Root Cause Analysis (RCA) to resolve payment integrity issues to resolution. Initiate project requests, develop or support the development of care cost impacts, partnering with external vendors, and/or Healthcare Economics. Support vendor relationship to ensure external and internal expectations are met.
Responsbilities
  • Responsible for analyzing specific contracts in Enterprise Payment Integrity.
  • Serve as a primary subject matter expert for each contract to ensure optimal contract management and outcomes.
  • Evaluate feasibility of implementing interim workflow processes as a stop gap to provider abrasion and interest payments.
  • Act as a point of communication and coordination with all internal business units for all issues related to vendor contracts.
  • Ensure current and future state analysis is performed, business requirements and change requests are analyzed and accurately documented and aligned with business needs.
  • Responsible for "end to end" contract management which includes performing all pre-contractual and implementation activities, business ownership of EPMO and IT projects, development of contract performance standards and associated penalties, root cause analysis and ongoing monitoring and oversight.
  • Review content of new Payment Integrity contracts and provide input as appropriate
  • Partner with business and IT to develop testing strategy, test plans and functional test cases. Participate in the development and execution of user test plans to ensure that the system design meets business needs.
  • Actively participate in all related Policy Meetings, Quarterly Business Reviews, Reimbursement Policy Committees, Steering Committees.
  • Create monthly savings reports and identify and address trends in comparison to established goals.
  • Support budget process by creating requisitions, purchase orders, and accruals for each Payment Integrity program, to ensure program alignment with budget.
  • Complete monthly invoices and reconcile against Oracle system reporting.
  • Identify system enhancements and process improvements which will result in enhanced reporting and savings.
  • Apply project management skills to complete related projects and assignments.
  • Initiate claims to determine under and overpayments, presents outcomes and seeks appropriate business approvals.
  • Identify and recommend new programs, savings opportunities, and ways to optimize current contracts.
  • Evaluate feasibility of implementing interim workflow processes as a stop gap to provider abrasion and interest payments.
  • Complete assigned Maestro cases in the appropriate Payment Integrity queues to ensure case closure within SLAs.
  • Engage vendors and internal business units to review opportunities and lead business case development, savings opportunity analysis, and creation of EPMO or IT related projects.

Qualifications
  • Bachelor's degree
  • AAPC CPC - AAPC Certified Professional Coder &/or CCS - AHIMA Certified Coding Specialist (Preferred)
  • Master's Degree (Preferred)
  • 4 - 6 years or relevant, professional experience in health care contracting and management (Required)
  • Strong understanding of the healthcare industry, managed care and health plan operations (Required)
  • Experience in managing large, complex contracts (Required)
  • Additional experience/specialized training/certifications may be considered in lieu of educational requirements (Required)
  • Knowledge of accruals, invoicing and financial reporting (Required)
  • Experience with performance improvement (Required)
  • Ability to prioritize complex projects (Required)
  • Excellent organizational and project management skills (Required)
  • Proficiency in Microsoft product suite (Required)
  • Knowledge of claims operating platforms (Preferred)
  • Excellent communication skills; ability to interact appropriately/effectively across all departments and management levels (Required)

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