Remote Lead, Payment Integrity Auditing

Premera Blue Cross; United States; On-site; USD 119,000 - 231,000; Full time

Benefits offered by this job

Medical, vision, and dental coverage

Life and disability insurance

401K employer match

Tuition assistance

Wellness programs

Generous PTO

Employee recognition program

Job summary

Premera Blue Cross is seeking a Manager of Payment Integrity Auditing to lead a team of auditors responsible for DRG validation, itemized bill reviews, and post-payment audits. The role focuses on improving payment accuracy and reducing inappropriate healthcare expenditures from a remote/work-from-home setting.

You will oversee audit programs, drive data-driven improvements, and align activities with Premera’s compliance requirements and organizational goals.

Qualifications

• Bachelor's Degree or 8 years of relevant work experience
• 5 years of analytical experience in a technical, healthcare, or business-related discipline
• 3 years of experience leading medium to large-size payment integrity projects
• Certified Professional Coder designation or 6 years of payment integrity experience

Responsibilities

• Manage a team of clinical coding and payment integrity auditors, ensuring high performance and professional development.
• Direct work products related to payment integrity auditing processes and systems and provide recommendations to coordinate and optimize those processes.
• Establish team priorities—determine scope of projects, implementation, analytical work, and responsibilities of team.
• Hire, develop, supervise, and evaluate staff; provide timely feedback and coaching on performance and development.
• Communicate strategic direction of the payment integrity auditing program to staff and other Premera departments.
• Provide guidance on complex payment integrity issues, claim reviews, and timely execution of auditing activities.
• Foster a culture of continuous improvement, innovation, and collaboration within the team and across departments.
• Collaborate with leadership to align payment integrity activities with organizational strategies and compliance requirements.

Job description

Premera Blue Cross is seeking a Manager of Payment Integrity Auditing to lead a team of auditors responsible for DRG validation, itemized bill reviews, and post-payment audits. The role focuses on improving payment accuracy and reducing inappropriate healthcare expenditures from a remote/work-from-home setting.

You will oversee audit programs, drive data-driven improvements, and align activities with Premera’s compliance requirements and organizational goals.