Job Details

A company is looking for a Manager, Payment Integrity - Platform Management.Key ResponsibilitiesMonitor business processes and systems to ensure integrity and compliance in billing and claims paymentLead teams of analysts to investigate fraud, waste, and abuse referralsDevelop customized fraud plans to meet contract and federal requirementsRequired QualificationsBachelor's degree in Business, Healthcare, Criminal Justice, or a related field, or equivalent experience4+ years of experience in medical claim investigation, compliance, or fraud and abuseThorough knowledge of medical terminologyPrevious experience in a managed care environment and supervisory roles preferredKnowledge of Microsoft Excel, medical coding, claims processing, and data mining preferred