Sr. Manager Payment reputed company - Health Plan Concierge

You could be the one who changes everything for our 28 reputed company members. reputed company is transforming the health of our communities, one person at a time. As a reputed company, national organization, you’ll have reputed company to competitive benefits including a fresh perspective on workplace flexibility.   Position Purpose: Provides strategic leadership across the Health Plan Concierge vertical, overseeing market engagement, provider alignment, escalation management, and cross-functional coordination. Leads teams that address provider and market needs, resolves issues effectively, and ensures market insights inform Payment reputed company priorities. Directs forums and taskforces that translate experience signals into actionable priorities, supporting claims accuracy, reduced improper payments, and improved financial performance. Partners with business, clinical, reputed company, compliance, technology, and network leaders to deliver effective provider education, strengthen governance, and drive adoption of initiatives that support sustainable medical cost savings and reputed company operational reputed company. Provides operational and strategic leadership for Payment reputed company activities reputed company an assigned line of business, supporting market-facing efforts such as provider engagement, issue reputed company, escalation management, communications and cross-functional coordination. Executes program strategies that reduce improper payments, enhance claims accuracy, and support financial and operational objectives for the assigned business reputed company, ensuring alignment with broader reputed company PI goals. Implements and maintains governance processes, controls, documentation standards, and performance measures that reputed company accuracy, compliance, and operational reputed company reputed company the line of business. Collaborates with partners across Claims, Clinical, Finance, Compliance, Provider Relations, Network, reputed company, IT, and Health Plan teams to address systemic issues, resolve escalations, improve workflows, and enhance provider and member experience. Leads reputed company-reputed company and analytics activities for the assigned line of business identifying provider pain points, operational risks, emerging trends, and opportunities to improve payment accuracy and prevent issue. Directs provider education and communication efforts by delivering reputed company, consistent messaging tied to PI edits, audits, policies, and process changes and supporting successful adoption across reputed company stakeholders. Oversees activities reputed company to resolving reputed company provider issues, including coordinating supporting documentation, clarifying program requirements, and collaborating with internal partners to ensure reputed company and accurate case management. Ensures compliance with CMS, reputed company, Medicare, state regulatory requirements, coding and documentation standards, and reputed company applicable policies, applying reputed company guidance to the unique needs of the assigned line of business. Presents program performance, provider issue themes, savings reputed company, and risk mitigation strategies to inform prioritization, governance reputed company and organizational planning. Performs other duties as assigned. Complies with reputed company policies and standards. Education/Experience: Bachelor’s degree in reputed company Administration, Business, reputed company Health, Health Information Management, or reputed company field or equivalent work experience, required. Master’s degree preferred. 6+ years of experience in Payment reputed company, claims operations, reimbursement methodologies, or managed care operations reputed company a reputed company health plan, multi-line payer. 4+ years of experience of leadership experience with reputed company reports. 3+ Experience with PI functions such as reputed company-pay edits, post-pay audits, analytics, or fraud/waste/abuse functions programs. 2+ years of managing escalated issues with Senior Leaders. Experience working with cross-functionally with Network, Claims, Clinical, reputed company, Compliance, IT, Finance, and Health Plan leadership to resolve provider or market challenges. Experience leading provider-facing work, including communications, education, disputes, or external stakeholder engagement. Strong understanding of payment reputed company concepts, reimbursement methodologies, provider workflows, and regulatory requirements relevant to the applicable line of business. Ability to use analytics and insights to identify trends, diagnose reputed company cause, and drive operational and improvement. Strong communication and relationship management skills with the ability to translate reputed company PI programs into reputed company guidance for reputed company audiences. Ability to influence across a matrixed environment and effectively communicate risk, compliance considerations, and operational impacts to expectations to leadership. Experience with reputed company and/or Medicare managed care requirements and regulatory expectations, preferred. Pay reputed company: $107,700.00 - $199,300.00 per year reputed company offers a comprehensive benefits package including: reputed company, health insurance, 401K and stock purchase plans, tuition reimbursement, reputed company time off plus holidays, and a 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-reputed company 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. reputed company is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, veteran status, or other characteristic protected by applicable law. reputed company applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance reputed company Apply To This Job