Senior Manager, Payment Integrity - Vended Audit Programs

Overview

This role oversees and monitors the performance of internal and external cost recovery and cost containment initiatives. Responsibilities include managing vendor initiatives, partnering with health plans to identify and contain costs, and supporting implementation of action plans based on performance metrics and forecasted recovery and cost avoidance goals.

Responsibilities

• Oversee and monitor internal and external cost recovery and cost containment initiatives against targeted project metrics and forecasted recovery and cost avoidance goals for each Health Plan
• Manage internal and external vendor cost avoidance and cost recovery initiatives
• Partner with health plans to identify and contain costs through collaboration with national vendors for each recovery category
• Develop annual budget and projected targets for each national vendor and support vendors in achieving projected annual savings
• Evaluate and streamline existing processes; implement new processes to reduce costs
• Present trends and cost containment opportunities, recommend action plans, and assist with implementation of those plans
• Assist health plans in understanding rules, regulations, and processes around cost recovery
• Monitor other departments’ performance and processes and evaluate opportunities for cost recovery
• Compile and present reporting packages for Senior Management on current cost avoidance and cost recovery initiatives
• Perform other duties as assigned
• Comply with all policies and standards

Requirements

• Bachelor’s degree in Accounting, Finance, Healthcare Management, related field, or equivalent experience
• 6+ years of data analysis, finance, or accounting experience
• Experience with government programs auditing and compliance monitoring programs preferred
• Project management experience preferred

Compensation & Benefits

• Pay Range: $107,700.00 - $199,300.00 per year
• Comprehensive benefits package, including:
  • Health insurance
  • 401K and stock purchase plans
  • Tuition reimbursement
  • Paid time off plus holidays
  • Flexible approach to work with remote, hybrid, field, or office work schedules
• Actual pay will be adjusted based on an individual’s skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives.
• Benefits may be subject to program eligibility.

Location

• Remote, hybrid, field, or office work schedules (flexible approach to work location is supported).

Equal Opportunity

The employer is an equal opportunity employer committed to diversity. All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.