Ejep
Senior Director of Payment Integrity
Camp Hill, PA, United States · Director
Sponsorship not specifiedDetected 7 days ago
Data Analysis
About the role
- The Senior Director, Payment Integrity leads the enterprise function responsible for ensuring claims are paid accurately, appropriately, and in accordance with plan benefits, provider contracts, reimbursement policies, clinical guidelines, and regulatory requirements. This role is accountable for developing and executing strategies that prevent, detect,
- correct, and recover improper payments while reducing financial leakage, supporting cost containment, and improving operational quality. This leader oversees end-to-end payment integrity capabilities, including pre-payment accuracy, post-payment audit and recovery, clinical and coding review, reimbursement and payment policy, fraud, waste and abuse support,
Responsibilities
- This role is accountable for developing and executing strategies that prevent, detect, correct, and recover improper payments while reducing financial leakage, supporting cost containment, and improving operational quality.
- The role partners closely with Claims, Clinical, Provider Network, Finance, Compliance, Legal, Technology, Data Analytics, and external vendors to strengthen payment controls, improve claims administration, and supp...
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