Director, Claims & Payment Integrity (Remote)

OneHome; Town of Florida (NY); On-site; USD 139,000 - 191,000; Full time

Benefits offered by this job

Bonus incentive plan

Job summary

OneHome, Miramar, FL, seeks a Director, Claims Processing and Payment Integrity to oversee adjudication of claims and apply data mining to audit claims for accuracy, detect anomalies, and identify over- or under-payment. The role requires deep Medicare/Medicaid claims experience and cross-functional leadership to advance payment integrity across payer systems.

The candidate will drive strategic programs, improve provider satisfaction, and lead initiatives to reduce cost while ensuring timely and

Qualifications

• Bachelor's degree or higher required; extensive Medicare/Medicaid claims experience preferred.
• At least 8 years in claims management with a focus on payment integrity.
• Ability to collaborate across departments and drive initiatives.
• Strong communication, confidentiality, and analytical skills.

Responsibilities

• Oversee adjudication of claims and payments.
• Audit claims for accuracy using data analytics.
• Detect anomalies and investigate potential fraud, waste, and financial recovery.
• Lead large-scale programs and improve provider contract payment accuracy.

Skills

Bachelor's Degree

Medicare/Medicaid claims management

Cross-department collaboration

Communication skills

Financial trend analysis

Confidentiality

Provider payment accuracy

Education

Bachelor's Degree

Master's Degree

Tools

Microsoft Office

Excel

Plexis

Oracle

Lucidchart

Visio

Job description

OneHome, Miramar, FL, seeks a Director, Claims Processing and Payment Integrity to oversee adjudication of claims and apply data mining to audit claims for accuracy, detect anomalies, and identify over- or under-payment. The role requires deep Medicare/Medicaid claims experience and cross-functional leadership to advance payment integrity across payer systems.

The candidate will drive strategic programs, improve provider satisfaction, and lead initiatives to reduce cost while ensuring timely and