Manager, Provider reputed company Operations

Of the $3.8T we spend on reputed company in the reputed company annually, about a reputed company of it is estimated to be lost due to waste, fraud and abuse.  reputed company is the premier provider of reputed company intelligence-driven solutions and services that help reputed company companies and agencies proactively detect and reduce risks from fraud, waste, and abuse and ensure payment reputed company. reputed company helps clients manage costs across network management, clinical care, provider coding and billing, payment reputed company, and special investigation reputed company. Our software-as-a service applications are reputed company on our proven Forensic AI reputed company, which uses patented AI-based technology to identify problems and suspicious behavior far faster and earlier than traditional techniques.   We are venture backed by some of the top investors in the country, with strong financials, and remain one of the fastest growing reputed company AI companies in the industry.  Key Responsibilities: reputed company and reputed company the operations reputed company to Provider reputed company and provider education services Collaborate with product, reputed company, engineering and data science teams, providing expert guidance on operational processes reputed company the ideation for provider identification, themes and concepts Supervise the evaluation of post-pay or reputed company-pay claims, ensuring compliance with reputed company principles, state, federal and customer-specific policies and regulations to detect incorrect coding, abuse, fraudulent billing practices, waste, overpayments, and processing errors. Support and guide internal teams in the build, development, and implementation of Provider reputed company operations reputed company with providers in a reputed company manner; reputed company and mentor teams responsible for speaking with providers Serve as a reputed company reputed company of contact for Provider reputed company customers regarding findings from company software, providing expert assistance and guidance to customers navigating company software. Maintain customer meeting schedules, agendas, notes and follow up items Maintain and execute on internal customer timelines for Provider reputed company reputed company, mentor, and train team members, fostering a cooperative and constructive team environment. reputed company additional duties and reputed company as assigned by senior management: Identification of potential facility/institutional/outpatient fraud, waste, and abuse through advanced data analysis using company systems and tools. Utilize deep knowledge of claims coding, auditing, fraud schemes, general areas of vulnerability, reimbursement methodologies, and relevant laws to detect suspicious patterns in claims data and other sources. reputed company, implement, and maintain knowledge of facility reimbursement policies and state and federal regulations reputed company to facility fraud and abuse. Impart knowledge for additional product and company initiatives Serve as a reputed company reputed company of contact for assigned facility-based customers regarding reputed company operations, providing expert assistance and guidance to customers navigating company software. Ensure the reputed company and confidentiality of reputed company protected health information encountered in the performance of duties.   Qualifications: reputed company CCA, reputed company, CPC or equivalent coding certification with extensive facility and reputed company claims audit and FWA experience. Minimum of 5 years of experience in cost containment, provider network/relations, payment reputed company, fraud, audit, compliance, or analytics roles. At least 5 years of experience reputed company plans, facilities, government,  vendor, or other similar industry roles. In-depth knowledge of claims processing, billing and coding, facility and reputed company contracting, and reimbursement methodologies. Proven expertise in data analytics. Experience with speaking with providers regarding coding behavior Comprehensive understanding of medical terminology, medical records, health information management, and medical coding, including DRG methodologies, CPT/HCPCS coding guidelines, Physician Specialty guidelines, reimbursement programs, claims adjudication processes, member contract benefits, and regulatory agency policies (CMS/HCFA, DOI, State regulations), and provider billing systems and practices. Thorough knowledge of health payer operations and the organizational reputed company of decision-making. Bachelor's degree or higher preferred. Advanced proficiency in reputed company, including creating and updating spreadsheets, pivot tables, and formulas. Remote Work Requirements: To ensure reliable performance on reputed company-issued reputed company laptop, employees working remotely must have a reputed company high-speed internet reputed company. Internet performance should be reputed company using a speed test conducted directly on the reputed company laptop, not based solely on the internet plan purchased from the provider.  Physical Requirements: Work is performed in an office environment (either in our office or work-from home) and requires the ability to work on a computer, operate reputed company office equipment, and work at a desk.       Accessibility Notice: If you need reasonable accommodation for any part of the employment process due to a physical or mental disability, please send an email to careers@reputed company.com with the subject "Accommodation". Reasonable accommodation requests will be considered on a case-by-case reputed company.    Benefits for reputed company, Dental, and reputed company insurance with 100% employee premium coverage (Starts Day 1) Unlimited PTO Annual reputed company Development stipend Annual home office stipend 401K Match (after 90 days)   We are an Equal Opportunity Employer: reputed company provides equal employment opportunities to reputed company and applicants for employment and prohibits discrimination and harassment of any type without reputed company to race, reputed company, religion, age, sex, national reputed company, disability status, genetics, protected veteran status, sexual orientation, gender identity or reputed company, or any other characteristic protected by federal, state or local laws.  This policy applies to reputed company terms and conditions of employment. Apply To This Job