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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
Lead Program Manager, Clinical Labs

Lead Program Manager, Clinical Labs

Exact Sciences

Madison, WI • On-site

$109K - $185K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 18 days ago

Exact Sciences rating

8.5

Company rating: 8.5 out of 10

Based on 54 frontline employees who took The Breakroom Quiz

19th of 103 rated laboratories

Job description

Help us change lives
At Exact Sciences, we're helping change how the world prevents, detects and guides treatment for cancer. We give patients and clinicians the clarity needed to make confident decisions when they matter most. Join our team to find a purpose-driven career, an inclusive culture, and robust benefits to support your life while you're working to help others.
Position Overview
The Program Manager successfully delivers solutions to support the organization's vision and strategic direction. This role manages and leads large, high risk, high visibility, and critical projects across the organization. These projects are often highly complex and impact many users. This position ensures successful integration and communication between multiple projects. This is a hands-on role that requires close collaboration with all levels of Exact Sciences.
Essential Duties
include but are not limited to the following:
  • Lead and coach multiple efforts and teams to deliver work successfully.
  • Apply project management methodologies and best practices.
  • Work with business stakeholders to define strategy and requirements in order to define and execute a collection of projects across the business.
  • Develop schedules, budgets, risk management plans, quality goals, and lead the team to success.
  • Maintain detailed program metrics around initiative goals and communicate progress to key stakeholders.
  • Lead team effort in improvements; define action items to increase the velocity and quality of the program.
  • Drive positive change management via planning, communications, and relationship management.
  • Make critical decisions based upon a combination of data analysis, experience, and judgement.
  • Formulate, organize, and monitor inter-connected projects to include coordination of cross-project activities.
  • Develop and mentor program and project team members.
  • Listen, influence, negotiate, and mitigate conflict while building relationships achieving desired results.
  • Partner with multiple internal cross-functional teams and successfully manage multiple projects simultaneously.
  • Uphold company mission and values through accountability, innovation, integrity, quality, and teamwork.
  • Support and comply with the company's Quality Management System policies and procedures.
  • Regular and reliable attendance.
  • Ability to work nights and/or weekends, as needed.
  • Ability to work designated schedule.
  • Ability to lift up to 10 pounds for approximately 5% of a typical working day.
  • Ability to work on a mobile device, tablet, or in front of a computer screen and/or perform typing for approximately 90% of a typical working day.
  • Ability to comply with any applicable personal protective equipment requirements.
  • Ability and means to travel between local Exact Sciences locations.
  • Ability to travel up to 10% of working time away from work location, may include overnight/weekend travel.

Minimum Qualifications
  • Bachelor's Degree aligned with key functions of the role, or Associates Degree and 2 years of relevant experience, or High School Degree and 4 years of relevant experience
  • Demonstrable expertise of project management methodology and frameworks
  • 8+ years project management experience with increasing responsibility of scope and leadership.
  • 5+ years managing and leading large impact, large budget, high risk, client facing, and critical projects.
  • 5+ years using Project Management software.
  • Authorization to work in the United States without sponsorship.
  • Demonstrated ability to perform the Essential Duties of the position with or without accommodation.

Preferred Qualifications
  • Master's Degree.
  • PMI certification.
  • Experience working in a regulated environment (FDA, CAP/CLIA, ISO15189, ISO13485)
  • Experience working with operationalizing new products and/or assays
  • Experience working with automation of lab processes
  • Lean Six Sigma Green/Black Belt
#LI-JB1
Salary Range:
$109,000.00 - $185,000.00
The annual base salary shown is for this position located in US - WI - Madison on a full-time basis. In addition, this position is bonus eligible.
Exact Sciences is proud to offer an employee experience that includes paid time off (including days for vacation, holidays, volunteering, and personal time), paid leave for parents and caregivers, a retirement savings plan, wellness support, and health benefits including medical, prescription drug, dental, and vision coverage. Learn more about our benefits.
Our success relies on the experiences and perspectives of a diverse team, and Exact Sciences fosters a culture where all employees can develop personally and professionally with a sense of respect and belonging. If you require an accommodation, please contact us here.
Not ready to apply? Join our Talent Community to stay updated on the latest news and opportunities at Exact Sciences.
We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to disability, protected veteran status, and any other status protected by applicable local, state, or federal law.
To view the Right to Work, E-Verify Employer, and Pay Transparency notices and Federal, Federal Contractor, and State employment law posters, visit our compliance hub. The documents summarize important details of the law and provide key points that you have a right to know.

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