Manager Payment Integrity

About the role

Blue Cross and Blue Shield of Minnesota is seeking a dedicated and motivated individual to join their team. As a Blue Cross associate, you will be part of a culture that is committed to transforming healthcare.

Responsibilities

• Manages the claims overpayment and recovery department including interviewing and hiring employees following required EEO and Affirmative Action guidelines and ensuring employees receive the proper training.
• Conducts performance evaluation, and is responsible for managing employees, including skill and career development, policy administration, coaching on performance management and behavior, employee relations and cost control.
• Oversees and guides ongoing business analysis and integration activities including but not limited to development, data mining, business validation, testing and business deployment.
• Responsible for overpayment trend analysis, generation of enterprise savings opportunities and reporting.
• Provides consultation and support to internal and external stakeholders on business process activities.
• Participates in strategic planning to assure future operational needs and changes are defined and communicated.
• Identifies problems, develops constructive solutions, recommends specific management actions related to overpayments and follows through to implementation.
• Captures and coordinates staff in its performance in completion of business process and system enhancements relative to overpayment.
• Directs the measurement of performance and is accountable for meeting performance standards.
• Directs allocation of resources to meet internal and external recovery savings goals.
• Accountable for meeting budget goals and assuring department operates within their approved budget.
• Performs additional responsibilities consistent with the scope and level of the role, as assigned.

Requirements

• 5+ years of progressive customer service/operations experience, with 1+ staff, team lead or project lead experience.
• Bachelor’s degree; in lieu of a degree, an additional two years of relevant experience beyond the qualifications listed above may be accepted.
• Healthcare payer and/or payment integrity experience strongly preferred.
• Previous people leadership experience managing teams with diverse job functions, titles, and grade levels is strongly preferred.
• Ability to communicate expectations and priorities clearly to team members, actively listen to resolve issues and remove barriers, and drive alignment across teams and stakeholders.
• Ability to analyze department challenges, guide team decision-making, and collaborate across teams to drive resolution and next steps.
• Ability to effectively organize team work, balance priorities across projects, and manage time and resources to ensure timely delivery and coordination.
• Databricks, Python, SQL, SSIS, SSRS and/or Power BI experience.
• Serves as a data expert across a variety of legacy and contemporary data sources and is recognized as having a skill set that few within the organization have.
• Knowledge of medical terminology and healthcare regulations.
• Understanding of public programs and government business (e.g., Minnesota Department of Human Services, Centers for Medicaid and Medicare Services).
• Claims processing experience.
• Strong attention to detail and accuracy.
• Masters degree in related field.

Qualifications

Role Designation: Hybrid Anchored in Connection

Physical Requirements: Not specified

Pay and Benefits

Compensation Range: $117,800.00 - $159,000.00 - $200,200.00 Annual Pay is based on several factors which vary based on position, including skills, ability, and knowledge the selected individual is bringing to the specific job. We Offer a Comprehensive Benefits Package Which May Include Medical, dental, and vision insurance, Life insurance, 401k, Paid Time Off (PTO), Volunteer Paid Time Off (VPTO), and more.

Equal Employment Opportunity Statement

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. Blue Cross of Minnesota is an Equal Opportunity Employer and maintains an Affirmative Action plan, as required by Minnesota law applicable to state contractors. All qualified applications will receive consideration for employment without regard to, and will not be discriminated against based on any legally protected characteristic. Individuals with a disability who need a reasonable accommodation in order to apply, please contact us at: talent.acquisition@bluecrossmn.com.