Dir Pre-Payment Review 97961

Company Name:
Responsible for the administration and operational effectiveness of the pre-payment review team whose main responsibility is to manage the prepay review program continuum. Primary duties may include, but are not limited to: Evaluates and monitors the prepay review process for improvements during implementation while ensuring consistent administration across the enterprise. Coordinates with InvestiClaim Triage teams, Special Investigations Units, Claims Operations, and Grievances and Appeals to continuously improve the Pre-Payment Review Program. Monitors activities and operational metrics in order to report and meet or exceed cost of care savings goals. Manages the criteria for on-boarding and off-boarding of providers from the Pre-Payment Review Program. Maintains visibility and participates in improvement efforts within all aspects of the end to end Pre-Payment Review Program. Requires a BA/BS; 10 years of experience in healthcare, including 5 years of management experience; or any combination of education and experience, which would provide and equivalent background. Fraud and abuse experience preferred.
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Title: Dir Pre-Payment Review 97961
Location: AZ-Scottsdate
Requisition ID: 97961

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