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Payment Integrity Program Manager Jobs in Wisconsin

Surge Staffing

Program Manager

Nashotah, WI · On-site

$55K - $60K/yr

Reconcile invoices to ensure accuracy in preparation for final approval and payment processing ... management program as necessary * Reconcile invoices from all vendors and prepare for final ...

Apply Early

Surge Staffing

Program Manager

Nashotah, WI · On-site

$55K - $60K/yr

Reconcile invoices to ensure accuracy in preparation for final approval and payment processing ... management program as necessary * Reconcile invoices from all vendors and prepare for final ...

Leonardo DRS

Program Manager

Menomonee Falls, WI · On-site

We are seeking a highly motivated Program Manager to lead complex, cross-functional programs ... The Leonardo DRS culture is defined by our Core Values and Principles: - Integrity - Agility ...

Madison-Kipp Corporation

Program Manager

Madison, WI · On-site

... integrity. · Offer new technology alternatives to customers for potential cost reductions and ... program management activities. LANGUAGE SKILLS * Ability to read, write, and understand English.

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Ametek

Program Manager

Madison, WI · On-site

CAMECA Instruments is seeking an experienced NPD Program Manager, for their APT Technology to lead ... Ethics and Integrity, Respect for the Individual, Inclusion, Teamwork, and Social Responsibility.

BCforward

Program Manager II

Waukesha, WI · On-site

$37/hr

Program Manager II 12/12/2016 to 05/31/2017 Waukesha, WI, USA, 53188 $37/hr on w2 BACHELORS DEGREE ... integrity team to drive used part setup. 4. Maintain harvest master parts list and communicate ...

Johnson Controls

BMS Program Manager

Milwaukee, WI · Remote

$1.0K/wk

The Program Manager is responsible for developing and delivering Power BI dashboards that provide ... Demonstrates Johnson Controls values and a strong commitment to integrity and accountability.

Johnson Controls

BMS Program Manager

Milwaukee, WI · On-site

The Program Manager is responsible for developing and delivering Power BI dashboards that provide ... Demonstrates Johnson Controls values and a strong commitment to integrity and accountability.

Becton, Dickinson and Company

This position provides program management and high-level operational support, focusing on ... Provide support for data management and uphold reporting integrity, ensuring information is ...

Becton, Dickinson and Company

This position provides program management and high-level operational support, focusing on ... Provide support for data management and uphold reporting integrity, ensuring information is ...

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All JobsPayment Integrity Program Manager JobsPayment Integrity Program Manager Jobs in Wisconsin

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.

What are popular job titles related to Payment Integrity Program Manager jobs in Wisconsin? For Payment Integrity Program Manager jobs in Wisconsin, the most frequently searched job titles are:
What job categories do people searching Payment Integrity Program Manager jobs in Wisconsin look for? The top searched job categories for Payment Integrity Program Manager jobs in Wisconsin are:
What cities in Wisconsin are hiring for Payment Integrity Program Manager jobs? Cities in Wisconsin with the most Payment Integrity Program Manager job openings:
Payment Integrity Program Manager jobs near you
Clinical Provider Auditor II - Payment Integrity SIU

Clinical Provider Auditor II - Payment Integrity SIU

Elevance Health

Waukesha, WI • Hybrid

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 25 days ago

Elevance Health rating

7.7

Company rating: 7.7 out of 10

Based on 345 frontline employees who took The Breakroom Quiz

180th of 277 rated insurance

Job description

Anticipated End Date:

2026-06-26

Position Title:

Clinical Provider Auditor II - Payment Integrity SIU

Job Description:

Clinical Provider Auditor II - Payment Integrity SIU

Location: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Carelon, a proud member of the Elevance Health family of companies, is a healthcare services organization that takes a whole-health approach to making care more integrated, personalized, and affordable. We put people at the center-connecting physical, behavioral, social, and pharmacy services, along with clinical expertise, research, operations, and advanced technology to help care work better, together.

Among us are care providers, engineers, data scientists, and other dedicated professionalsdetermined to recover, eliminate and prevent unnecessary medical-expense spending.

The Clinical Provider Auditor II is responsible for identifying issues and/or entities that may pose potential risk associated with fraud and abuse.

How you will make an impact:

  • Examines claims for compliance with relevant billing and processing guidelines and identifies opportunities for fraud and abuse prevention and control.

  • Reviews and conducts analysis of claims and medical records prior to payment and uses required systems/tools to accurately document determinations and continue to next step in the claims lifecycle.

  • Researches new healthcare related questions as necessary to aid in investigations and stays abreast of current medical coding and billing issues, trends and changes in laws/regulations.

  • Collaborates with the Special Investigation Unit and other internal areas on matters of mutual concern.

  • Recommends possible interventions for loss control and risk avoidance based on the outcome of the investigation.

  • Assists with training of new associates.

Minimum Requirements:

  • Requires a AA/AS and minimum of 3 years medical coding/auditing experience, including minimum of 1 year in fraud, waste abuse experience; or any combination of education and experience, which would provide an equivalent background.

  • Requires coding certification (CPC, CCS, CPMA).

Preferred Experience:

  • Prepay review of Medicare and Medicaid experience highly desired.

  • Knowledge of ICD-10 and CPT/HCPC coding guidelines and terminology and Bachelor's degree strongly preferred.

Job Level:

Non-Management Exempt

Workshift:

1st Shift (United States of America)

Job Family:

FRD > Audit

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.


Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.


How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.


We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.


Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.


The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.


Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.


Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.


NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words - the job is posted until 3/13, not through 3/13.

What Elevance Health employees say

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About Elevance Health

Sourced by ZipRecruiter

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Indianapolis, IN, US

Year founded

2004

Social media

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