Healthcare Payment Integrity Lead (FWA/COB/Subrogation) - Minneapolis
- - Operations - Administrative Platform
- Minneapolis, MN, USA
- Full Time
Bind is a health technology and services company founded in 2016 and headquartered in Minneapolis, MN with satellite offices in New York and San Francisco. Bind is health insurance for the way we live now. Unlike traditional health insurance that charges you for services you may never need or want, Bind is on demand: pay for what you need, not what you don't, and adjust your coverage when those needs change. Health coverage that's flexible, clear, and intuitive.
We are creative, collaborative, and a little bit fiery. The Bind team is comprised of like-minded individuals passionate about healthcare, and our cause is the collective act of rewiring it. We embrace new ideas. We're more wheel than cog. More spark than smoke. And we are playful and venturesome in our daily mission to render real and refreshing solutions to health insurance that works better for us all.
Healthcare Payment Integrity Lead (FWA, COB, Subrogation)- Minneapolis
Our newly created Healthcare Payment Integrity Lead will develop, implement, and manage the cost containment capabilities for Bind by identifying and mitigating potential fraud waste and abuse. Collaborate with other department management and staff, as well as external business partners to optimize the cost containment capabilities for Bind, including managing or coordinating internal and external resources.
• Manage the relationship and performance of vendors to identify, categorize and mitigate potential fraud, waste, and abuse; leads or supervises internal performance as required.
• Develop the roadmap development and foster implementation of payment integrity capabilities to augment and enhance current detection of potential fraud, waste, and abuse.
• Analyze trends and operational performance data to identify inefficiencies and implement process improvements.
• Develop and recommend strategies and tactics to effectively support the needs of the payment integrity program.
• Interact and collaborate with internal stakeholders and external partners to drive operational excellence and maintain positive relationships supporting business goals and objectives.
• Leverage cross-functional resources to expand visibility and enhance predictability of expected results.
• Provide technical knowledge and develop and drive strategies for continually improving operational performance related to payment integrity.
• Partner with payment integrity best practice business partners to elevate the capabilities of Bind.
• Develop innovative approaches to creating a high performing organization understanding and leveraging industry best practice to delivery best in class/world class operational services.
• Create policies and procedures to support Bind's payment integrity program and ensure compliance with current regulatory standards and internal policies and procedures.
• Serve as a subject matter expert to help resolve complex cases and respond during internal and external audits.
• Bachelor's degree in Business Administration, Health Management, or related field.
• A minimum of 8 years of managed care operations experience, including lead or management experience.
• Strong knowledge of insurance terminology and benefit plan coverage and exclusions.
• Deep understanding of healthcare industry constituents and their needs.
• Managed care programs, operations and practices in both a provider and insurer perspective.
• Strong working knowledge of health plan payment integrity processes and systems, including core claims and administrative systems.
• Business ethics and related concepts in managed care programs.
• Claim and payment auditing principles and practices, also with a focus on potential fraud, waste, and abuse.
• Vendor and/or supervisory management approaches and practices.
• Project management principles and practices.
• Communicate effectively and build relationships at all levels of the organization.
• Be flexible, adapt to change.
• Develop and recommend strategies to mitigate potential fraud, waste and abuse.
• Review and monitor operational performance and identify areas for improvement of optimization.
• Analyze large amounts of details, claims and information to establish facts, identify trends and draw conclusions.
• Serve as the subject matter expert to influence, optimize and drive change.
• Demonstrate a high degree of professionalism and business ethics.
• Manage and/or supervisor of vendors and/or employees.
• Manage multiple tasks and priorities in a highly dynamic environment, strong problem-solving skills, and exceptional attention to detail.
Bind is committed to providing equal employment opportunities. All qualified applicants and employees will be considered for employment and advancement without regard to race, color, religion, national origin, sex, disability, age, marital status, sexual orientation, veteran status, genetic information, or any other status protected by applicable law.