Payment Integrity and FWA Concept Development Lead

locations

Remote USA

time type

Full time

job requisition id

R2540

Job Description

A bit about this role:

At Devoted, our mission is to build trust with our providers and members by ensuring claims are paid accurately and on time with transparent policies. Our Payment Integrity Department is at the forefront of this effort, ensuring provider claims are paid correctly, free of errors, and aligned with contractual terms.

You will be responsible for identifying and researching new medical cost savings opportunities. We're looking for an individual who is a subject matter expert in healthcare payment policies and practices, but more importantly, a creative problem-solver who can conceive of new ways to reduce costs and improve accuracy. You'll be a hands-on operator, bringing these new concepts to life by building the workflows and processes to support them.

Your responsibilities and impact will include:

• Develop innovative payment integrity concepts and programs.

• Leverage your deep subject matter expertise to research opportunities for cost savings and improved claim accuracy.

• Design and build the operational workflows necessary to implement new programs from the ground up, ensuring they are effective and sustainable.

• Work closely with a variety of internal teams to understand the root cause of payment inaccuracies and drive program success.

• Effectively manage multiple projects and priorities, from initial concept to full implementation.

Required skills and experience:

• Bachelor's degree and a minimum of 4 years of relevant professional experience.

• A proven subject matter expert in U.S. healthcare, with a strong understanding of medical claims, billing, and payment policies.

• Demonstrated ability to develop new concepts and ideas for cost savings and process improvement.

• A track record of designing and implementing new operational processes and workflows.

• The ability to leverage analytical tools and data to research ideas and support new concepts.

• Excellent verbal, written, and presentation skills for collaborating with and influencing stakeholders at all levels.

Desired skills and experience:

• A strong understanding of claims adjudication and revenue cycle management.

• Familiarity with data querying tools like SQL.

• Certified Professional Coder (CPC) or similar certification.

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Salary range: $95,000 - $120,000 /year

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.

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!

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.