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Carelon Payment Integrity Manager – Behavioral Health
| Company | Elevance Health |
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| Location | Hanover, MD, USA |
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| Salary | $93828 – $140742 |
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| Type | Full-Time |
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| Degrees | Bachelor’s |
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| Experience Level | Senior |
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Requirements
- Requires a BA/BS in business, engineering, nursing, finance, or healthcare administration and minimum of 5 years related work experience, including minimum of 2 years leadership experience; or any combination of education and experience, which would provide and equivalent background.
Responsibilities
- Has detailed technical knowledge of claims payment accuracy and participates on cross functional teams focused on problem remediation and long term resolution.
- Anticipates the effect of changes in the business environment on future claim errors.
- Evaluates regulatory compliance and Health Care Reform changes to determine potential impact.
- Evaluates provider activities to assist in the detection of fraud, waste and abuse activities.
- Monitors provisions of the compliance plan, including fraud, waste, and abuse policies and procedures, investigates unusual incidents and implements corrective action plans.
- Develops and analyzes monthly reports.
- Develops project plans and oversees project execution, issue management and progress reporting.
- Develops processes to support early detection of systemic issues causing operational inefficiencies.
Preferred Qualifications
- MBA preferred.
- Prior Behavioral Health auditing experience preferred.
- CPC is preferred.
- Proficiency with Excel/MS Word preferred.
