Carelon Payment Integrity Manager - Kansas

About the role

This role requires associates to be in-office 1-2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace.

Responsibilities

• Coordinate and respond to inquiries from executives, ensuring timely and accurate communication.
• Handle the processing and management of Payment Integrity waivers.
• Aid in preparing responses to Requests for Proposals across all lines of business.
• Document process flows accurately to ensure clear and effective communication of processes.
• Help with preparing presentations, ensuring they are polished and ready for delivery.
• Review and approve performance guarantees, ensuring compliance with standards.
• 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.
• Makes sure the compliance plan, including fraud, waste, and abuse policies and procedures, is being followed.
• 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.

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 and equivalent background.

Preferred Skills, Capabilities, and Experiences

• 2-5 years of experience with Fraud, Waste and Abuse.
• Experience with payment integrity.
• Familiarity with claims systems and processes.
• Experience with GBD Facets.

Benefits

At Elevance Health, we offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Pay

Details on pay are not specified in this posting.

Schedule

The Carelon Payment Integrity Manager - Kansas is a hybrid role, requiring associates to be in-office 1-2 days per week.