Talent.com
Director, Payment Integrity - Coordination of Benefits and Data Mining
Director, Payment Integrity - Coordination of Benefits and Data MiningBlue Cross and Blue Shield of North Carolina • Jackson, MS, United States
Director, Payment Integrity - Coordination of Benefits and Data Mining

Director, Payment Integrity - Coordination of Benefits and Data Mining

Blue Cross and Blue Shield of North Carolina • Jackson, MS, United States
[job_card.variable_days_ago]
[job_preview.job_type]
  • [job_card.full_time]
[job_card.job_description]

Job Description

Direct, manage and lead highly complex functional and / or broad foundational business areas within Payment Integrity to define and enable strategic and operational priorities. Lead and set goals for teams responsible for identifying, coordinating, and implementing initiatives / projects and activities that create efficiencies, optimize systems & processes, promote quality, and maximize medical and administrative expense savings. Teams may include Payment Integrity strategy and growth, operations, payment integrity clinical and specialty programs, and / or multiple payment integrity services either performed by vendors or internally.

Leadership Responsibilities

  • People leadership
  • Resource management
  • Project planning and management
  • Financial and data analysis

What You'll Do

  • Provide leadership, vision, and direction for assigned teams.
  • Direct staff of subject matter experts and analysts to identify & execute growth business initiatives, while managing existing programs : production problem resolution, system enhancements, and configurations.
  • Accountable to define and execute strategy to deliver year-over-year growth and achieve savings target(s) within the COB and Data Mining vertical.
  • Ensure business plans and industry analysis, consider future needs and drive "best in-class" thinking. Builds understanding of market trends and customer needs.
  • Identifies new operational initiatives and modifications to current programs and processes to improve the company's competitive position / increase medical expense savings.
  • Demonstrates understanding of the financial levers that impact business performance and deploys them to improve short- and long-term results.
  • Lead and oversee management and delivery of enterprise and departmental projects including business case development, ROI analysis, planning, business analysis, and project management.
  • Lead and oversee optimization of existing systems, processes, and workflows.
  • Ensure programs and operations are performing successfully and are compliant in accordance with regulations of State, Federal, and other governing bodies; ensures corrective action plans are implemented when applicable.
  • Develop internal PI Provider Education program to enhance provider experience and focus on change in behavior.

    • What You'll Bring

  • Bachelor's Degree
  • 10 years of experience managing multifunctional payment integrity teams
  • In lieu of bachelor's degree, 12 years of experience as stated above
  • Must have direct health plan experience
  • 7 years leadership experience

    • Preferred skills

  • Extensive knowledge of coordination of benefit primacy rules for commercial and Medicare lines of business, including knowledge of MSP demand process
  • Basic claim coding knowledge for better understanding of data mining concepts
  • Experience with project and software life cycle management
  • Experience with vendor management from an operational perspective
  • Experience with vendor contract negotiations
  • Understanding of claims adjudication systems and pricing configuration and architecture
  • Coding and billing experience

    • What You'll Get :

    The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community

    Work-life balance, flexibility, and the autonomy to do great work

    Medical, dental, and vision coverage along with numerous health and wellness programs

    Parental leave and support plus adoption and surrogacy assistance

    Career development programs and tuition reimbursement for continued education

    401k match including an annual company contribution

    Learn more

    Salary Range

    At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs.Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus

  • , 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.
  • Based on annual corporate goal achievement and individual performance.

    • $157,978.00 - $252,765.00

    Skills

    [job_alerts.create_a_job]

    Director Coordination • Jackson, MS, United States

    [internal_linking.similar_jobs]
    Hiring Now- Data Modernization Director

    Hiring Now- Data Modernization Director

    InstantServe LLC • Jackson, MS, United States
    [job_card.full_time]
    Job Title : Data Modernization Director.Experience overseeing all day-to-day aspects (planning, organizing, budgeting, etc. Collection, cataloging and leveraging of large amounts of data across multi...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Remote Accounting Expert - AI Trainer ($50-$60 / hour)

    Remote Accounting Expert - AI Trainer ($50-$60 / hour)

    Data Annotation • Jackson, Mississippi
    [filters.remote]
    [job_card.full_time] +1
    We are looking for a finance professional to join our team to train AI models.You will measure the progress of these AI chatbots, evaluate their logic, and solve problems to improve the quality of ...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Field Medical Director, Pain Management

    Field Medical Director, Pain Management

    Evolent • Jackson, MS, United States
    [job_card.full_time]
    Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Remote Accounting Manager - AI Trainer ($50-$60 / hour)

    Remote Accounting Manager - AI Trainer ($50-$60 / hour)

    Data Annotation • Jackson, Mississippi
    [filters.remote]
    [job_card.full_time] +1
    We are looking for a finance professional to join our team to train AI models.You will measure the progress of these AI chatbots, evaluate their logic, and solve problems to improve the quality of ...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Associate Director, Tax

    Associate Director, Tax

    KPMG • Jackson, MS, United States
    [job_card.full_time]
    Known for being a great place to work and build a career, KPMG provides audit, tax and advisory services for organizations in today's most important industries. Our growth is driven by delivering re...[show_more]
    [last_updated.last_updated_1_day] • [promoted]
    Director, Global Revenue Recognition

    Director, Global Revenue Recognition

    Mississippi Staffing • Jackson, MS, US
    [job_card.full_time]
    Revenue Recognition Technical Program Office.The Revenue Recognition Technical Program Office is a diverse and high-performing team of motivated professionals who apply deep technical accounting an...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Manager, Medicare Claims

    Manager, Medicare Claims

    Blue Cross and Blue Shield of North Carolina • Jackson, Mississippi, United States
    [job_card.full_time]
    The Manager, Medicare Claims, oversees end-to-end claims services for provider segments, meeting business goals.This role sets performance targets, manages claims processing and financials, handles...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Director Data Services

    Director Data Services

    Mississippi Staffing • Jackson, MS, US
    [job_card.full_time]
    This job is responsible for developing the strategy, planning and delivery of all aspects related to data governance, data warehousing, data management and related efforts for the organization.Dire...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Senior Director, Conduct Compliance Programs Officer

    Senior Director, Conduct Compliance Programs Officer

    KPMG • Jackson, MS, United States
    [job_card.full_time]
    Known for being a great place to work and build a career, KPMG provides audit, tax and advisory services for organizations in today's most important industries. Our growth is driven by delivering re...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Managing Director and Associate General Counsel, Lead Audit Counsel

    Managing Director and Associate General Counsel, Lead Audit Counsel

    KPMG • Jackson, MS, United States
    [job_card.full_time]
    Known for being a great place to work and build a career, KPMG provides audit, tax and advisory services for organizations in today's most important industries. Our growth is driven by delivering re...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Travel CT Tech - $1,148 per week in Hattiesburg, MS

    Travel CT Tech - $1,148 per week in Hattiesburg, MS

    AlliedTravelCareers • Jackson, Mississippi, US
    [job_card.full_time]
    Atlas Medstaff is currently seeking candidates in the CT Tech (CT Tech) profession for a 13 week contract in the Hattiesburg, Mississippi area. Atlas Medstaff is a premier staffing firm dedicated to...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Consulting Technical Management Director - Oracle Health

    Consulting Technical Management Director - Oracle Health

    Oracle • Jackson, MS, United States
    [job_card.full_time]
    This director position is responsible for managing.Part of the engineering and implementation pillar team that is responsible for delivery of enterprise Federal healthcare system.Directing multiple...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Remote Senior Accountant - AI Trainer ($50-$60 / hour)

    Remote Senior Accountant - AI Trainer ($50-$60 / hour)

    Data Annotation • Jackson, Mississippi
    [filters.remote]
    [job_card.full_time] +1
    We are looking for a finance professional to join our team to train AI models.You will measure the progress of these AI chatbots, evaluate their logic, and solve problems to improve the quality of ...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Remote Investment Analyst – AI Trainer ($50-$60 / hour)

    Remote Investment Analyst – AI Trainer ($50-$60 / hour)

    Data Annotation • Jackson, Mississippi
    [filters.remote]
    [job_card.full_time] +1
    We are looking for a finance professional to join our team to train AI models.You will measure the progress of these AI chatbots, evaluate their logic, and solve problems to improve the quality of ...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Director Claims

    Director Claims

    Mississippi Staffing • Jackson, MS, US
    [job_card.full_time]
    The Director Claims directs activities within the General and Auto Liability Claims, Physical Damage Repairs and Property and Cargo Claims, including the management of loss control activities and t...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Director of Allowance for Credit Losses

    Director of Allowance for Credit Losses

    Origin Bank • Jackson, MS, US
    [job_card.full_time]
    Duties and Responsibilities include the following : .Advises and assists department managers, officers, and staff in their respective functions associated with the areas for which he or she has direc...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Director, External Expert Strategy & Engagement

    Director, External Expert Strategy & Engagement

    Otsuka America Pharmaceutical Inc. • Jackson, MS, United States
    [job_card.full_time]
    The Director, External Expert Strategy & Engagement is a critical role responsible for defining, standardizing, and overseeing the company's global strategy for engaging a broad spectrum of externa...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Director, Risk Management Advisory - Government

    Director, Risk Management Advisory - Government

    KPMG • Jackson, MS, United States
    [job_card.full_time]
    Known for being a great place to work and build a career, KPMG provides audit, tax and advisory services for organizations in today's most important industries. Our growth is driven by delivering re...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]