Remote Payment Integrity Lead - Audits, Data & Leadership

Network Health Administrative Services, LLC; Menasha (WI); On-site; USD 90,000 - 120,000; Full time

Job summary

Network Health Administrative Services, LLC seeks a Supervisor of Payment Integrity to lead audits, data analysis, and investigations of claims and enrollment activities. You will guide a team, ensure accuracy, and implement corrective actions as needed.

The role requires a Bachelor’s degree and 3+ years in health care or health insurance with 1+ year leadership. It is a 1.0 FTE position based in Wisconsin with home-office eligibility and periodic travel to Menasha.

Qualifications

• Bachelor’s degree or equivalent work experience.
• 3+ years in health care or health insurance.
• 2+ years in quality assurance or auditing.
• 1+ years in leadership or mentoring.
• Knowledge of health care practices and compliance concepts.
• Ability to motivate and guide a team to reach goals.
• Clear reporting of team performance results.

Responsibilities

• Interviewing, disciplinary actions, payroll and rules enforcement.
• Review scheduled audits timely and accurately.
• Oversee fraud, waste and abuse investigations and reporting.
• Oversee payment accuracy and QA audits and reporting.
• Develop and implement audit algorithms to improve payment accuracy.
• Lead department through regular team meetings and performance reviews.
• Hire, train, and manage team time and performance.
• Develop dashboards showing audit progress and outcomes.
• Develop and maintain audit policies and procedures.

Skills

Leadership

Team mentoring

Data analysis

Communication

Education

Bachelor’s degree or equivalent

Tools

Audit dashboards

Quality assurance tools

Job description

Network Health Administrative Services, LLC seeks a Supervisor of Payment Integrity to lead audits, data analysis, and investigations of claims and enrollment activities. You will guide a team, ensure accuracy, and implement corrective actions as needed.

The role requires a Bachelor’s degree and 3+ years in health care or health insurance with 1+ year leadership. It is a 1.0 FTE position based in Wisconsin with home-office eligibility and periodic travel to Menasha.