HealthPartners · 18 hours ago
Payment Integrity Production Manager
Bloomington, MN
Full-time
Onsite
Mid, Senior Level
4+ years expHealthPartners is a nonprofit, integrated health care organization that is hiring a Payment Integrity Operation Manager. This role is responsible for managing daily operations and personnel for the payment integrity team, ensuring a high-quality experience for health plan partners through effective systems and processes.
MedicalPharmaceutical
Responsibilities
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
Qualification
Required
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
Benefits
Health
Time off
Retirement planning
Continuous learning opportunities
Company
HealthPartners
HealthPartners, an integrated health care organization providing health care services and health plan financing and administration, was founded in 1957 as a cooperative.
10001+ employees
H1B Sponsorship
HealthPartners has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (2)
2024 (26)
2023 (41)
2022 (37)
2021 (44)
2020 (52)
Funding
Current Stage
Late StageTotal Funding
$116M2020-05-07Debt Financing· $110M
2016-05-02Grant· $6M
Leadership Team
Penny Cermak
Executive Vice President and Chief Financial Officer
William Frey II
Research Director, Center for Memory & Aging, Neurosciences
Recent News
Canadian News Wire
2023-01-23
2022-12-07
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