Manager, Cost Containment

Virginia Premier – Glen Allen, VA

About Us Don’t just find a job, find your WHY at a purpose-driven organization; discover a career at Virginia Premier. By blending quality benefits, affiliating with the world-renowned VCU Health System and offering career-advancing development programs, we allow our employees to focus on the meaningful work of improving and saving the lives of more than 200,000 people throughout the state of Virginia. At Virginia Premier, we are building an industry leading health care organization through dedicated teams that have heart, provide top-notch quality member services and embrace our mission of inspiring healthy living within the communities we serve. Our vision is to connect people to innovation, quality and affordable health care for all phases of life. If this sounds like you, read on! Overview POSITION OVERVIEW This position is responsible for managing multiple lines of business including multiple Medicaid and Medicare offerings. The responsible candidate will ensure federal and state contractual expectations are maintained for each line of business as it relates to claim payment accuracy guidelines. Additionally, the candidate will be responsible for auditing of the claim payment system, identifying overpayments, managing overpayment recoveries, and identifying process improvement opportunities. The identification and reduction of fraud, waste, and abuse will be the primary focus for team that this individual leads. Responsibilities POSITION DUTIES AND RESPONSIBILITIES

  • Establishing acceptable claim auditing programs, processes and policies to ensure accurate payment of claims
  • Develop staff including individualized growth plans and training
  • Analyze data for trends and forecasting
  • Recommend changes to adjudication logic based on data analysis
  • Perform testing on data extracts and systems
  • Develop in-depth understanding of all claim systems that impact payments
  • Identify trends and processes for improvement, lead efforts to implement changes to improve overall quality
  • Perform periodic contract audits to ensure billing and payments are in accordance with contract terms
  • Perform periodic fee schedule audits to ensure fees are current and accurate
  • Develop strategies for evaluating process efficiency and effectiveness
  • Create and implement strategies for managing external vendor effectiveness
  • Develop strategies for make-buy decisions for auditing payment methodologies such as subrogation, NCCI, and various payment groupers such as APC, AP-DRG, MS-DRG, and EAPG
  • Handle miscellaneous duties/activities as directed by management
  • Qualifications MINIMUM EDUCATION REQUIREMENTS
  • Bachelor's Degree required, preferably in Business or Health Care Administration
  • SPECIAL KNOWLEDGE AND/OR SKILLS
  • Strong analytical and problem solving skills
  • Knowledge of quality assessment criteria
  • Knowledge of CPT and ICD coding
  • Knowledge of various claim types
  • Knowledge of various types of claim payment scenarios
  • WORK BACKGROUND/EXPERIENCE
  • Minimum 3 years in a supervisory or leadership capacity
  • Minimum 1 – 2 years in a healthcare setting
  • Experience in quality improvement techniques, such as Six Sigma, beneficial
  • PHYSICAL REQUIREMENTS
  • Physical health sufficient to meet the ergonomic standards and demands of the position.
  • All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE Our mission is to inspire healthy living within the communities we serve!

    This job posting is no longer available on OPTnation.
    Find similar jobs: on Job Search

    All Jobs in Glen Allen, VA

    • Landscape Account Manager

      Kirby's Landscaping Mechanicsville, VA

      View Job
    • Dispatcher/Driver Manager

      Cox Transportation Services, Inc. Ashland, VA

      View Job
    • Project Manager

      Green Air Inc Ashland, VA

      View Job
    • Construction Project Manager

      M.L. Bell Construction Richmond, VA

      View Job
    • Facility Supervisor - University Recreation

      University of Richmond Richmond, VA

      View Job
    • Survey Project Manager

      Timmons Group, Inc. Richmond, VA

      View Job
    • Assistant Manager

      Massage Envy Glen Allen, VA

      View Job
    • Lime Production Assistant

      Lime Glen Allen, VA

      View Job
    • Lime Production Assistant

      Lime Mechanicsville, VA

      View Job
    • Crewman II

      James River Grounds Management, Inc. - 718 Glen Allen, VA

      View Job
    • Assistant Manager

      Massage Envy Richmond, VA

      View Job

    Featured Articles

    SAP ESS MSS Online Training For All Business Areas

    29 April 2016

    SAP ESS stands for SAP Employee Self-Service and SAP MSS stands for SAP Manager Self-Service. SAP ESS and MSS are web-enabled tools used by the employee to update their data themselves and used for managers to update the data of their subordinate. SAP ESS covers data from various business areas: wor

    read more..

    President Trump’s “Merit-Based Immigration” System for H-1B and L-1 Visas could benefit Indians

    03 March 2017

    After taking the strong step on the ban of travel to the US by citizens from seven Muslim countries as an executive order; now Mr. Trump softens stand on immigration. US President Donald Trump called for a “merit-based i

    read more..

    Benefits Of Acquiring CPT Internship Opportunities

    21 September 2015

    Curricular Practical Training is the off campus work authorization provided to international students which has to be curricular related directly affecting the studies of stude

    read more..

    Already Have An Internship? Time To Turn Into Job

    14 September 2015

    Many international students who go to United States on F1 visa for their further graduation take the internship programs which later can turn up to be beneficial for them as it gets converted into the permanent job. This is not so simple and easy as it seems but with

    read more..

    Thanks For Your Feedback

    OPT Nation© 2018 Powered By Ragns Inc

    Attach A Resume First