Manager Coding

JOB REQUIREMENTS: Description Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for. We\'re a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration - because success is a team sport. It\'s our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued. The Manager, Coding is responsible for the Payment Analytics\' and Reimbursement Policy departments to ensure appropriate provider claim payment. The position will include visibility to senior leadership through reporting of results and trending of findings month over month. This position will be responsible for reverse engineering vendor savings, identifying medical cost leakage, share insight and absorb information that may lead to future findings. The duties of this position will have oversight and responsibility for communicating team results and working collaboratively to drive improvements through trending of pre-payment solutions, recoveries, the accuracy of claims payment, volume of claims adjustments, impact to provider service, degree of financial liability, and impact to provider billing pattern changes. This is a working Manager position and may require the candidate to perform, review or summarize audits and includes training incoming staff on audit practices and procedures. Performs other duties as assigned. Key Accountabilities Recovery Oversight & Vendor Management Develop a forecast of potential and error savings goals for analyzing claims data Oversee the day-to-day processes used by analysts to perform monthly savings efforts Recover overpayments identified through retrospective data analytics Uncover root cause of errors, influence stakeholders, sponsor process improvement, and continuously enhance claims editing solutions Develop and maintain good working relationship with Medica\'s claim processing vendor to drive ongoing claim policy management to enhance claim processing accuracy and adjustment reduction Maintain up-to-date knowledge of corporate policies, regulatory codes, legislative directive, and other guidelines Set priorities for staff dedicated to following up on payment integrity leads from vendors Auditing and Reporting Develop executive reporting package Comprehend Medica\'s contracting strategy and how it relates to our provider reimbursement and system capabilities Report overpayments or suspected fraudulent behavior to our Special Investigations Unit (SIU) Monitor, manage and report... For full info follow application link. Equal Opportunity Employer including Veterans and Disabled Individuals ***** APPLICATION INSTRUCTIONS: Apply Online: ipc.us/t/40008A910347470C