Manager, Payment Integrity Auditing

Workforce Classification: Telecommuter   Join Our Team: Do Meaningful Work and Improve People’s Lives  Our purpose, to improve customers’ lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare. Premera is committed to being a workplace where people feel empowered to grow, innovate, and lead with purpose. By investing in our employees and fostering a culture of collaboration and continuous development, we’re able to better serve our customers. It’s this commitment that has earned us recognition as one of the best companies to work for.  Learn more about our recent awards and recognitions as a greatest workplace. Learn how Premera supports our members, customers and the communities that we serve through our Healthsource blog:  https://healthsource.premera.com/ . As the Manager of Payment Integrity Auditing , you will lead a team of Clinical Coding and Payment Integrity Auditors and oversee the organization's payment integrity audit programs to ensure claims are reimbursed accurately and in compliance with contract provisions, payment policies, coding standards, clinical guidelines, and regulatory requirements. This role is responsible for developing and executing audit strategies across multiple audit types, including DRG validation, itemized bill reviews, level of care reviews, hospital readmission audits, and other post-payment and pre-payment audit initiatives. You will monitor audit performance, oversee internal and vendor audit activities, identify payment and billing trends, and leverage data-driven insights to improve payment accuracy, reduce inappropriate healthcare expenditures, and strengthen the organization's overall payment integrity strategy. This is a remote/telecommuter position working from home. What you’ll do: Manage a team of clinical coding and payment integrity auditors, ensuring high performance and professional development. Direct work products that are primarily related to payment integrity auditing processes and systems and provide recommendations to coordinate and optimize those processes and systems. Establish team priorities - determine scope of projects, implementation, analytical work, and responsibilities of team. Hire, develop, supervise, and evaluate staff; provide employees with timely feedback and coaching regarding performance at regular intervals and professional development opportunities through work assignments, special projects, further education, and feedback. Communicate strategic direction of the payment integrity auditing program, to both staff and other Premera departments. Provide guidance on complex payment integrity issues, claim reviews, and ensure timely execution of payment integrity auditing activities. Foster a culture of continuous improvement, innovation, and collaboration within the team and across departments. Collaborate with…