Carelon Payment Integrity Manager

Company	Elevance Health
Location	Indianapolis, IN, USA, Louisville, KY, USA, Nashville, TN, USA, Tampa, FL, USA, Wallingford, CT, USA, Richmond, VA, USA, Winston-Salem, NC, USA, St. Louis, MO, USA, Norfolk, VA, USA, Portland, ME, USA, Waukesha, WI, USA, Atlanta, GA, USA, Grand Prairie, TX, USA
Salary	$Not Provided – $Not Provided
Type	Full-Time
Degrees	Bachelor’s
Experience Level	Senior

Requires a BA/BS in business, engineering, nursing, finance, or healthcare administration
Minimum of 5 years related work experience
Minimum of 2 years leadership experience

Coordinate and respond to inquiries from executives, ensuring timely and accurate communication
Handle the processing and management of Payment Integrity waivers
Assist in preparing responses to Requests for Proposals across all lines of business
Document process flows accurately to ensure clear and effective communication of processes
Help with preparing presentations, ensuring they are polished and ready for delivery
Review and approve performance guarantees, ensuring compliance with standards
Has detailed technical knowledge of claims payment accuracy and participates on cross functional teams focused on problem remediation and long term resolution
Anticipates the effect of changes in the business environment on future claim errors
Evaluates provider activities to assist in the detection of fraud, waste and abuse activities
Monitors provisions of the compliance plan, including fraud, waste, and abuse policies and procedures, investigates unusual incidents and implements corrective action plans
Develops and analyzes monthly reports
Develops project plans and oversees project execution, issue management and progress reporting
Develops processes to support early detection of systemic issues causing operational inefficiencies

Must have experience or strong knowledge in payment integrity
Familiarity with claims systems and processes, with knowledge of systems like Facets, WGS, or CS90