Manager, Payment Integrity Recovery Services

Job Category: Claims

Department: Claims Integrity

Location:

Los Angeles, CA, US, 90017

Position Type: Full Time

Requisition ID: 8975

Salary Range: $102,183.00 (Min.) - $132,838.00 (Mid.) - $163,492.00 (Max.)

Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure our members get the right care at the right place at the right time.

Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.

As a condition of employment, L.A. Care requires a COVID-19 vaccine. This requirement includes our remote workforce. If you would like to request an exemption, L.A. Care has implemented a process to consider exemptions, for documented medical conditions and sincerely held religious beliefs. L.A. Care will review all exemption requests prior to proceeding with the recruitment process.

Job Summary

The Manager, Payment Integrity-Recovery Services is responsible for leading and managing the operations of the Payment Integrity Recovery Services Unit in achieving the strategic and operational objectives of the department. The position will actively manage the Recovery Services staff, the recoveries of overpayments identified by L.A. Care and its vendors, and provide support to the larger Payment Integrity Department.

Duties

Manage Recovery Services staff and drive accountability across team. Maintain quality goals and production levels within the Recovery Services unit. Ensure production goals associated within Recovery Services are consistently achieved. Assist in the development and implementation of vision, strategies, and tactics to maximize the department's effectiveness while minimizing costs.

Track and trend the inventory, platform reconciliation, operational and staff metrics associated within the Recovery Services unit and prepare and present written and verbal reports. Develop daily, weekly, and monthly dashboards. Review statistical data of various systems to verify accuracy and timely processing.

Manage staff, including, but not limited to: monitoring of day to day activities of staff, monitoring of staff performance, mentoring, training, and cross-training of staff, handling of questions or issues, etc. raised by staff, encourage staff to provide recommendations for relevant process and systems enhancements, among others.

Create, maintain, and monitor Recovery Services unit documents including policies, procedures, desktop procedures, workflow documents, and job aids. Ensure internal controls are appropriate and develop policies and procedures and ensures compliance with government regulations and licensing bodies.

Provide cross-functional management support of Payment Integrity programs and counsel to senior management. Work with other areas for solutions to complex problems and participate in critical interactions with both internal and external customers.

Provide TPL application oversight and management as well as management of TPL related team members.

Perform other duties as assigned.

Education Required

Bachelor's Degree in Public Health or Health Administration

In lieu of degree, equivalent education and/or experience may be considered.

Education Preferred

Experience

Required:
At least 5-7 years of demonstrated years of financial claims recovery experience in a Managed Care/ Health Care setting with at least 2 years of supervisory/management experience.

Extensive experience in overseeing and proficiency with PC-based computer systems, MS Office skills (Word, Excel, PowerPoint), and ability to learn and effectively use new information systems and software required.

Demonstrated depth of knowledge and experience in processing Health Plan claims of a complex nature.

Experience with managed care systems, medical claims and billing or electronic medical record required.

Preferred:
Medicare/Medicaid experience.

Full claim cycle understanding / General Accounting Practices / Training experience / QNXT experience / Strong Management experience.

Skills

Required:
Solid understanding of claims processing and claims data analysis.

Verbal and written proficiency and clarity in English language required.

Knowledge of Health Insurance Portability and Accountability Act (HIPAA) regulations and privacy laws.

Persuasion Skills: Standard persuasion/communication skills to communicate to varying levels of stakeholders.

Financial Impact: General Accounting Practices.

Licenses/Certifications Required

Licenses/Certifications Preferred

Medical Billing Certification

Medical Coding Certification

Required Training

Additional Information

Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.

L.A. Care offers a wide range of benefits including

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

At L.A. Care, we value our team members’ safety. In order to keep our work locations safe, each employee is required to self-screen for symptoms prior to entering any L.A. Care location each day. L.A. Care and all of its staff are required to comply with all state and local masking orders. Therefore, when on-site at any L.A. Care location, employees are expected to wear a mask in areas where physical distancing cannot be managed.