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This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
Senior Manager, Program Integrity – CPC, RHIT, RHIA required
Location
United States
Posted
140 days ago
Salary
$94.1K - $164.8K / year
Seniority
Senior
Job Description
Senior Manager, Program Integrity – CPC, RHIT, RHIA required
CareSource
• Implement optimization opportunities for prepay and post pay medical record auditing procedures and processes improvement auditing timeliness and quality outcomes • Oversee and ensure that supporting business and regulatory processes and documentation exists and kept current • Track and communicate production issues and escalations to ensure proper follow-up and coordination • Maintain project plans for all projects in which configuration is involved and ensure proper completion of those plans and escalation where timeframes will be changed • Lead new product and new vendor implementations to ensure timeliness and quality of new implementations • Develop and implement ticket controls and ensure that proper communication and approvals are in place prior to system implementation • Oversight and management of team of medical record coding auditors • Analyze and make a determination of appropriate reimbursements and/or modifications of Coding review guidelines in partnership with medical directors and clinical staff.
Job Requirements
- Bachelor’s degree or equivalent years of relevant work experience is required
- Minimum of five (5) years of experience in medical policy is required
- Minimum of five (5) years of management experience is required
- Health plan experience is required
- Facets and clinical editing system or equivalent system experience is required
- Advanced computer skills and abilities in Facets
- Proficient in Microsoft Suite to include, Word, Excel, and Access
- Knowledge of regulatory reporting and compliance requirements
Benefits
- Bonuses tied to company and individual performance
- Substantial and comprehensive total rewards package
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