Director Payment Integrity-SWHR

Education
Bachelor's Degree Healthcare Administration, Business, Public Health, or related field is required. Or,
Master's Degree Healthcare Administration, Business, Public Health, or related field preferred

Experience
8 years direct payment integrity experience with meaningful results. Strong knowledge of medical terminology is required. Previous experience in managed care environment with the ability to effectively hire, lead, and develop team members, along with strong organizational, planning, analytical, and problem-solving skills is also preferred.

Licenses and Certifications
CPC - Certified Professional Coder preferred upon hire

Skills
Claims processing is required.
Knowledge of Microsoft Excel, Microsoft PowerPoint.
Knowledge of Microsoft PowerBI or Tableau, Microsoft Visio, medical coding, and data mining are preferred.
Excellent written and verbal communication.
Strong attention to detail with excellent analytical, problem solving, organizational, and time management.
Working knowledge of regulations and requirements regarding health plan claims operations (CMS, ERISA, HIPAA, TDI, etc.).
Fully conversant with business operations and system requirements related to the managed care industry.
Self-motivated with confident decision-making abilities; able to focus in a fast-paced environment and manage time-sensitive issues and complex projects within deadlines and budget.
Dynamic presentation skills.
Knowledge of provider network arrangements and reimbursement methodologies, claims processing, and various types of health care benefit programs (including commercial and government programs).

The SWHR network includes physicians from UT Southwestern and Texas Health, and independent community primary care and specialty physicians. In partnership, our team implements physician-driven, value-based care strategies to coordinate care for more than 700,000 patients, resulting in lower costs and high-quality care.  In 2020, the Centers for Medicare & Medicaid Services released the annual financial and quality results and, based on the report, SWHR is one of the nation’s leading Next Generation Accountable Care Organizations, having saved nearly $120 million since joining the program in 2017. 
 

Why Southwestern Health Resources 
 

As a Southwestern Health Resources you’ll enjoy: comprehensive benefits, including a 401(k) with match; paid time off; competitive health insurance choices; healthcare and dependent care spending account options; wellness programs to keep you and your family healthy; tuition reimbursement; a student loan repayment program; and more.  

Explore Southwestern Health Resources Careers for more information and to search all career opportunities.

Let’s move healthcare forward – together.