Oct 12, 2019
WellCare Health Plans The Sr. Manager, Payment Integrity oversees all aspects of the medical claim coding and payment policy activities, research and/or technical. Responsible for the performance results of the department. Responsible for Vendor Management. Reports to: Director, Payment Integrity Dept.: Ops/Payment Integrity Location: Tampa (Idlewild), FL Essential Functions: Implements initiatives by managing a detailed action plan, coordinating action steps with matrix partners, driving resolution of implementation related issues and education of matrix partners. Serves as a single point of contact for all policy and/or technical related issues specific to a project. Responsible for the performance management processes for direct reports including coaching, counseling, providing feedback,career planning, goal setting, and performance assessment. Manages process improvement initiatives, seeking root cause and developing appropriate corrective action. Establishes objectives, goals and performance measures for the function being managed. Interfaces with vendor manager and teams to foster partnership with the WellCare team and to align strategies for reaching goals. Coordinates activities to ensure key deliverables are met and resolves conflicting demands. Functions as corporate authority regarding medical claim editing and payment policy implementation and maintenance. Responsible for teams who research, define, vet, test, implement and maintain edits which scrub medical claims data for accuracy. Serves as primary contact for complex coding related and/or coding software issues. Assists in developing both short and long range plans for overall departmental activities. Oversee the implementation of programs and strategies. May make recommendations on matters of policy and/or software applications and approve changes in area of expertise. Performs other duties as assigned. Additional Responsibilities: Candidate Education: Required Bachelor's Degree in a related field or equivalent work experience Candidate Experience: Required 6 years of experience in Coding and/or Coding Application Required 3 years of experience in Leading others Required 2 years of experience in Managed Care/Health Insurance industry Candidate Skills: Advanced Demonstrated organizational skills Advanced Demonstrated project management skills Intermediate Demonstrated leadership skills Advanced Demonstrated written communication skills Advanced Demonstrated interpersonal/verbal communication skills Advanced Demonstrated analytical skills Intermediate Other Knowledge of regulatory requirements concerning Medicare and Medicaid preferred Intermediate Other Ability to assess impact of change Intermediate Other Communication skills sufficient to communicate clearly and grammatically both complex and simple messages to a wide audience either within or outside of the organization Technical Skills: Required Intermediate Microsoft Word Required Intermediate Microsoft Excel Required Intermediate Microsoft PowerPoint Required Intermediate Microsoft Project Required Intermediate Microsoft Outlook Preferred Intermediate Other Knowledge of Xcelys and Medical Code Editing Software About us Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at www.wellcare.com. EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.
Professional Diversity Network Tampa, FL, USA Full-Time