Payment Integrity Manager

Claims Cost Senior Manager

HealthPartners is hiring a Claims Cost Senior Manager to manage a comprehensive claim cost containment area for HealthPartners. This role provides direct administrative support to Claims Department processes, new business initiatives and participates in the development and implementation of key Administrative Systems projects and strategic operational initiatives. They will work directly with all levels of staff within the organization, providing leadership for administrative functions.

Accountabilities:

• Responsible for the supervision of staff, including having the authority to hire, transfer, lay off, promote, discipline and discharge, train, reward and review performance of employees. Ensures compliance to organizational and departmental policies and procedures.
• Provides management leadership for designated administrative areas. Facilitates communication with business functional leaders. IS, staff, officers and senior management, regarding operational and functional area development, impact analysis of new business initiatives, regulatory
• Directs the analysis of complex business operations, defines requirements. Performs feasibility studies and produces cost/benefit information, and completes requirement analysis.
• Ensures optimum benefit dollar recovery through third party liability provisions and claim refund activity.
• Develop recovery theory and investigative potential overpayments, and assess potential for financial recovery.
• Identify recovery opportunities through the detailed review of informational and data sources.
• Contribute to the development of operational processes within the team as well as policies and procedures.
• Identify critical issues needing resolution. If issues require senior management attention, work with each as necessary to address changes and strategic projects.
• Provides leadership for affordability and customer driven initiatives.
• Serve as administrative expert including for functional area(s) and issues related to Claims
• Represent HealthPartners in dealing with external and internal audit firms and other outside organizations.
• Meet or exceed targets established for recoveries.

Required Qualifications:

• Bachelors Degree
• 7-10 Years of related experience within a regulatory and or healthcare compliance environment preferred.
• Ability to search out and identify recovery and cost containment opportunities
• Effective leadership, change management and judgment skills
• Excellent communication skills; verbal, written skills
• Ability to establish positive relationships internally and with industry groups and regulatory agencies.
• Solid business acumen and good understanding of business processes and dependencies
• Healthcare data analysis experience.
• Strong customer focus and negotiation skills.
• Demonstrated skill in planning, organizing and time management.
• Ability to analyze and interpret data and communicate action plans.

Preferred Qualifications:

• Masters degree in business administration, or other health-related field

Decision-Making:

• Administrative division budget and priorities developed by the Vice President of Administration, Administrative Business Department Directors.
• This Manager will need to balance and manage multiple products and projects. External and Internal customers depend directly on the leadership and direction of this position
• This position will have broad latitude in direction and influencing the use of resources to achieve key performance indicator requirements. This position will operate with a high degree of independence in the execution of the function(s) responsibilities.
• Staff recruitment, retention, and training.