At Devoted Health, we’re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That’s why we’re gathering smart, diverse, and big-hearted people to create a new kind of all-in-one healthcare company — one that combines compassion, health insurance, clinical care, service, and technology - to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. Founded in 2017, we've grown fast and now serve members across the United States. And we've just started. So join us on this mission!
Job Description
A bit about this role:
At Devoted, we know that one of the most important ways we will build trust with our network of providers and members is to pay claims accurately and on time while having transparent payment policies. Our Payment Integrity Department ensures that provider claims are paid correctly by the responsible party, for eligible members, according to contractual terms, not in error or duplicate, and free of wasteful or abusive practices.
As a Payment Integrity Program Development Manager, you will be responsible for identifying and researching new medical cost savings opportunities to improve claim payment accuracy and reduce the overall medical spend. You will assess new opportunities by leveraging your subject matter expertise, researching and evaluating CMS policies and industry trends, analyzing Devoted claims performance, and cross-functional collaboration.
Your responsibilities and impact will include:
Leverage your subject matter expertise, policy research, industry trends, and internal and publicly available data to generate ideas
Collaborate with internal teams to identify claims payment inaccuracies, root cause, and the impact on medical expense
Proactively and independently analyze medical cost trending, claim processing trends, overpayments, and other claim and medical expense irregularities to identify opportunities to reduce cost, improve claim adjudication accuracy, introduce payment policy changes, and develop new payment integrity program
Independently create and iterate data sets to research ideas and develop data insights
Required skills and experience:
Bachelor's degree and a minimum of 4 years of relevant experience
Experience working in U.S. healthcare
Proficiency in a variety of analytical and data mining tools to generate ideas, analyze data sets, and perform root cause analysis
Strong communications skills (verbal, written, presentation, interpersonal) with all types/levels of audience
Ability to multitask and effectively prioritize critical tasks and conflicting requirements
Ability to understand, explain, and break down complex problems
Desired skills and experience:
Proficiency in performing data analysis and reporting using SQL queries and Google Sheets
Knowledge of claims adjudication and revenue cycle management
Experience with payment integrity concept ideation
Certified Professional Coder
Salary range: $95,000 - $115,000 annually
Our ranges are purposefully broad to allow for growth within the role over time. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered may depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.
Our Total Rewards package includes:
Employer sponsored health, dental and vision plan with low or no premium
Generous paid time off
$100 monthly mobile or internet stipend
Stock options for all employees
Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles
Parental leave program
401K program
And more....
*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.
Healthcare equality is at the center of Devoted’s mission to treat our members like family. We are committed to a diverse and vibrant workforce.
Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values and the way we do business.
As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.
If an employer mentions a salary or salary range on their job, we display it as an "Employer Estimate". If a job has no salary data, Rise displays an estimate if available.
Argenti is seeking a dedicated Operations Facilitator to support care technology services aimed at enhancing the lives of vulnerable service users across the country.
Lead the FSP operational strategy team as Executive Director at Precision for Medicine, driving strategic initiatives and enhancing department deliverables.
Join Channel Factory as a proactive NYC Office Manager/ Executive Assistant, playing a key role in office operations and executive support.
NBCUniversal is looking for a Freelance Remote Technical Operations Coordinator to manage schedules and coordinate equipment logistics for their projects.
Join Sight Partners as an ASC Manager and take charge of the surgical center's daily operations while fostering team development.
The Assistant General Manager will oversee daily operations and culinary excellence in a thriving restaurant environment.
Fluence is seeking a Logistics Specialist who thrives in a dynamic environment to drive effective logistics operations across their projects.
Become a key player in live sports as a Hawk-Eye Systems Technician at Acrisure Stadium, ensuring seamless tech operations during Steelers home games.
Trove Brands seeks an experienced International Imports Coordinator to enhance their logistics processes and ensure smooth international shipping operations.
As the Head of Payment Operations at Finix, you'll spearhead critical partnerships within the payments landscape.
Join Sierra Nevada Company as a Logistics Specialist IV and play a key role in managing logistics for innovative aerospace and defense solutions.
Become a key player at Prime Healthcare as a Plant Operations Supervisor, ensuring operational excellence and safety at our Mesquite hospital.
Start your career with Enterprise Mobility as a Management Trainee and unlock a world of opportunities in a dynamic learning environment.
Subscribe to Rise newsletter