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Manager, Payment Integrity at PacificSource Health Plans - ApplyBlast

Manager, Payment Integrity

PacificSource Health Plans

4 months ago

3.1 on Glassdoor

Colorado

Onsite

Full Time

Manager

0 applicants

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About this role

The Manager of Payment Integrity leads the strategic design and execution of programs to improve payment accuracy and enhance member affordability within PacificSource. This role oversees pre- and post-payment programs, manages external vendors for fraud detection, and ensures compliance with federal and state regulations regarding coding and reimbursement. By collaborating with Health Care and Finance divisions, the manager drives operational efficiencies and fosters innovative partnerships to expand the reach of payment integrity initiatives.

Responsibilities

Lead the development and execution of enterprise-wide payment integrity strategies
Oversee comprehensive pre- and post-payment programs including audits and subrogation
Manage external vendors supporting audits, analytics, and fraud detection
Direct Fraud Waste and Abuse detection efforts with compliance teams
Ensure compliance with CMS, Medicaid, and ACA guidelines for accurate coding