Carelon Payment Integrity Manager - Behavioral Health
Supports Payment Integrity & Behavioral Health
Location: This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of our Hanover, MD PulsePoint location.
Carelon Payment Integrity is a proud member of the Elevance Health family of companies. Carelon Insights, formerly Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical-expense spending.
A proud member of the Elevance Health family of companies, Carelon Behavioral Health, formerly Beacon Health Options, offers superior clinical mental health and substance use disorder management, a comprehensive employee assistance program, work/life support, specialty programs for autism and depression, and insightful analytics to improve the delivery of care.
The Payment Integrity Manager is responsible for ensuring the accuracy of claims payment through the management of a robust process for prevention, detection, and correction of billing, payment and membership errors. Works with health plan leaders, oversees the monitoring and enforcement of the fraud, waste, and abuse compliance program to prevent and detect potential fraud, waste, and abuse activities pursuant to state and federal rules and regulations.
How you will make an impact:
- Has detailed technical knowledge of claims payment accuracy and participates on cross functional teams focused on problem remediation and long term resolution.
- Anticipates the effect of changes in the business environment on future claim errors.
- Evaluates regulatory compliance and Health Care Reform changes to determine potential impact.
- Evaluates provider activities to assist in the detection of fraud, waste and abuse activities.
- Monitors provisions of the compliance plan, including fraud, waste, and abuse policies and procedures, investigates unusual incidents and implements corrective action plans.
- Develops and analyzes monthly reports.
- Develops project plans and oversees project execution, issue management and progress reporting.
- Develops processes to support early detection of systemic issues causing operational inefficiencies.
Minimum Requirements
- Requires a BA/BS in business, engineering, nursing, finance, or healthcare administration and minimum of 5 years related work experience, including minimum of 2 years leadership experience; or any combination of education and experience, which would provide an equivalent background.
Preferred Skills, Capabilities and Experiences
- MBA preferred.
- Prior Behavioral Health auditing experience preferred.
- CPC is preferred.
- Proficiency with Excel/MS Word preferred.
For candidates working in person or remotely in the below location, the salary range for this specific position is $93,828 to $140,742.
In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).
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.
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