Head of Payment Integrity & Compliance

SIHO Insurance Services; United States; A distancia; USD 120.000 - 150.000; Jornada completa

Descripción de la vacante

SIHO Insurance Services seeks an exempt leader who will report to the Vice President of Operations and set strategy for QA, Grievances & Appeals, and FWA teams. You will manage day-to-day operations across SIHO departments, guiding regulatory interpretation to ensure CMS and state compliance.

You will oversee staffing, performance management, and vendor data transfers, driving quality assurance programs and compatibility with Medicare Advantage, ACA, and evolving state regulations.

Formación

• Requires a B.S. degree or equivalent healthcare operations experience with 3–5 years in managed care.
• Proficiency in Excel and strong understanding of Medicare Advantage, ACA, and state insurance regulations.

Responsabilidades

• Oversee staffing, performance management, and regulatory interpretation to maintain CMS and state compliance.
• Monitor FWA trends, manage vendor data transfers, and support claims quality assurance programs.

Conocimientos

Regulatory interpretation

Staffing & performance management

CMS regulations

Medicare Advantage knowledge

Analytical skills

Educación

Bachelor's degree or equivalent healthcare operations experience

Herramientas

Excel

CMS Part C Reporting

SOC audits

Descripción del empleo

SIHO Insurance Services seeks an exempt leader who will report to the Vice President of Operations and set strategy for QA, Grievances & Appeals, and FWA teams. You will manage day-to-day operations across SIHO departments, guiding regulatory interpretation to ensure CMS and state compliance.

You will oversee staffing, performance management, and vendor data transfers, driving quality assurance programs and compatibility with Medicare Advantage, ACA, and evolving state regulations.