Payment Integrity Production Manager

HealthPartners is hiring a Payment Integrity Operation Manager. This position is accountable for managing the daily operations and personnel for payment integrity team. The manager is responsible for designing, implementing, and refining systems, processes, and reporting to ensure a high-quality, scalable experience for health plan partners. They will work and collaborate with all levels of staff within the organization, provider leadership and management of payment integrity staff, staffing analysis and meeting key customer metrics.

ACCOUNTABILITIES:

• Responsible for the supervision of staff, including having the authority to hire, transfer, lay off, promote, discipline and discharge, train, reward and review performance of employees. Ensures compliance to organizational and departmental policies and procedures.
• Management leadership for designated payment integrity department and its day to day activities. Including coaching/training staff to maintain high service standards and meet regulatory requirements.
• Fosters a culture of continuous improvement in the Payment Integrity department to enhance data integrity. Facilitates collection of statistical data and reports for health plan, clinic staff and group policyholders.
• Conducts analysis of claim data to determine recommendation for changes or modification to programs to the Director, Payment Integrity.
• Facilitates oversight in payment integrity operations in avoidance, claim editing, claim review third party liability and recovery services.
• Facilitate communication with business functional leaders, Medical Director, Clinic Managers, Information Services staff, senior management and officers regarding operations and functional areas of development, claims analysis and impact of new business initiatives, regulatory changes and strategic projects.
• Ensures KPI's are being met and SOP's are updated accordingly.
• Ensures accurate administration of member benefits, medical policy and provider reimbursement for all products. Ensures optimum benefit dollar recovery through third party liability provisions and claim refund activity.
• Participates in departmental planning as it relates to objectives, cost containment, future systems and division/corporate policies.
• Responsibility for compliance with Federal and State regulations affecting operational units, support accreditation requirements.
• Assist in coordinating department audits and audit readiness for state, federal and accreditor agencies.
• Participate in preparation of annual budget, department goals/objectives and long range strategic planning for the department. Maintains departmental expenditures within budget limitations.
• Assures that GHI's EEO/Affirmative Action Program is properly communicated, implemented and adhered to in an effort to achieve projected goals on corporate and divisional basis.
• Develop and maintain a broad base knowledge of health care industry and claims management. As well as HealthPartners administrative functions and systems
• Performs other duties as required.

REQUIRED QUALIFICATIONS:

• College degree with emphasis in business administration or equivalent experience in the management of a production area.
• At least four years experience in the health insurance industry.
• Previous supervisory or management experience.
• Concise and accurate written communication skills.
• Ability to make oral presentations and lead discussions
• Advance human relations skills
• Advanced analytical skills
• Advanced problem solving skills
• Detailed knowledge of the health care industry, including customer expectations on service and cost containment.
• Demonstrated skill in planning, organizing and time management.
• Ability to make logical decisions and meets deadlines.
• Ability to analyze and interpret data and communicate action plans via written documentation.