Lead, Payment Integrity & Audit

Network Health Administrative Services, LLC; Wisconsin; Hybrid; USD 85,000 - 110,000; Full time

Job summary

Network Health Administrative Services, LLC is seeking a Supervisor of Payment Integrity to lead the team responsible for claims audits, enrollment reviews, and investigations into fraud, waste and abuse. The role emphasizes data collection, reporting, and driving corrective actions across business areas.

The position requires 3+ years in health care or health insurance, QA/auditing experience, and at least 1 year of leadership.

Qualifications

• Bachelor’s degree or equivalent years of work experience required.
• 3+ years health care or health insurance experience required.
• 2+ years working in a quality assurance or auditing role required.
• 1+ years’ experience in leadership or mentoring required.
• Knowledge of health care industry practices and key compliance concepts.
• Ability to motivate and guide a team to reach established goals.
• Effectively communicate and report team performance results in a clear format.

Responsibilities

• Assumes responsibility for personnel duties including interviewing, disciplinary actions, payroll and enforcing required rules; consults with the director as needed.
• Responsible for accurate, timely and efficient review of scheduled audits.
• Oversee fraud, waste and abuse investigations and communicate findings and action steps.
• Oversee payment accuracy and QA audits and communicate findings and actions with departments.
• Partner with other departments to identify, develop and implement new audit algorithms to improve payment accuracy.
• Provide leadership through regular team meetings, one-on-one and performance reviews.
• Conducts hiring, training, and time and performance management for the team with HR guidance.
• Participates in problem solving and prioritizing review activities; reports results to leadership.
• Develop and maintain a reporting dashboard outlining progress and outcomes of all audits.
• Oversees development of audit policies and procedures.

Skills

Leadership

Mentoring

Team Management

Communication

Data Analysis

Quality Assurance

Health Care Compliance

Audit

Education

Bachelor’s degree or equivalent work experience

Job description

Network Health Administrative Services, LLC is seeking a Supervisor of Payment Integrity to lead the team responsible for claims audits, enrollment reviews, and investigations into fraud, waste and abuse. The role emphasizes data collection, reporting, and driving corrective actions across business areas.

The position requires 3+ years in health care or health insurance, QA/auditing experience, and at least 1 year of leadership.