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SalaryYour career starts now. We are looking for the next generation of health care leaders.
At AmeriHealth Caritas, we are passionate about helping people get care, stay well and build healthy communities. As one of the nations leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we would like to hear you.
Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.
Discover more about us at www.amerihealthcaritas.com.
The primary purpose of the job is to:
The position of Payment Integrity Analysis Manager is accountable for supporting and maintaining the department’s commitments to offsetting growing trends in Fraud, Waste, and Abuse. The Manager is responsible for managing the development, maintenance, and approval of policy and procedures for the organization. In addition, the Manager coordinates the delivery of department’s LOB implementation deliverables and responses to state/federal audit requirements.
The Manager leads the business requirements development process for the department’s recovery processing system. Works with stakeholders to elicit, analyze, and validate recovery processing system enhancement.
Policy and Procedures Management
- Manages the process to develop, document, and formalize policies and procedures in support of the department’s program to offset the growing trends in Fraud, Waste, and Abuse. This will include:
- Maintaining internal policy and procedures to ensure the documents are accurate and approved in compliance with established corporate guidelines.
- Partnering with departmental Subject Matter Experts (SMEs) to create and/or revise departmental procedures.
- Analyzing contractual requirements to identify and assess the impact on established departmental processes.
Program Integrity Coordination Management
- Enterprise involvement with strategic initiatives that interface with all levels within the organization to define and document repeatable processes.
- Manages preparation and submission of departmental state contract implementation deliverables. This will include coordination with department leadership on:
- Analyzing contract requirements to identify and assess impact on established departmental processes; and
- Tracking and monitoring the progress of departmental deliverables; and
- Submitting Program Integrity deliverable to the plan leadership and/or corporate department.
- Manages preparation and submission of departmental preparation and submission of Program Integrity state and/or federal audit deliverables. This will include coordination with department leadership on:
- Analyzing audit requirements to identify the appropriate Program Integrity Unit responsible for providing the requested deliverable; and
- Tracking and monitoring the progress of departmental deliverables; and
- Submitting Program Integrity deliverable to the plan leadership and/or corporate department.
Recovery Processing System
- Leads and/or participates in the analysis of recovery processing system enhancements.
- Facilitates or participates in meetings with various business, development, and QA stakeholders.
Education/ Experience:
- Bachelor’s Degree required
- Process documentation
- 5 to 8 years of prior experience in the following: process/project management and process/business analysis
Other Skills:
- Customer focused attitude
- Excellent interpersonal skills as well as a strong team player in order to elicit cooperation from a wide variety of sources
- Organization & coordination skills in order to balance creation and maintenance of numerous internal policy and procedures
- Flexibility to conform to shifting priorities with the ability to prioritize and execute tasks in a dynamic environment
- Self-motivated with the ability to work independently with limited supervision
Diversity, Equity, and Inclusion
At AmeriHealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.
We keep our associates happy so they can focus on keeping our members healthy.
Our Comprehensive Benefits Package
Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.
