Supervisor, Payment Integrity

Mar 13 2023
Category: Healthcare
Job Description

Job Summary

The Supervisor is responsible for the supervision of Internal Operations Payment Integrity, vendor processes and team activities. Responsibilities include oversight of payment integrity vendor audits including but not limited to TPL, Recovery, Front End Editing and Credit Balance. The Supervisor also manages Payment Integrity vendors such as Optum and Rawlings to ensure performance and quality levels for contracted services are efficient and accurate.


Minimum Qualifications

  • Bachelor's degree and 3 years of related work experience; or equivalent combination of education and work experience
  • 2 years of supervisory or management experience.
  • Basic working knowledge of Excel and PowerPoint. Intermediate working knowledge of Word and Email/Outlook.
  • Strong relationship and interpersonal skills to be applied when working with vendors and regulatory agencies across the entire payment integrity life cycle.
  • Effective verbal and written communication skills.
  • Strong project and process management skills, with the ability to handle multiple vendors and multiple contracts as well as a wide range of tasks.
  • Strong relationship and interpersonal skills to be applied when working with vendors
  • Experience analyzing processes, solving problems, and making recommendations for improvements.
  • Experience leading diverse teams to meet organizational goals in a matrix organization.


Duties and Responsibilities

  • Execute, monitor, and lead implementation of payment integrity strategy. Assess the success of payment integrity activities for continued alignment with organizational goals (e.g., Healthcare Cost Trend) and ensure expected results are being achieved.
  • Communicating external teams' outcomes, data analysis, complex processes and action plans to internal teams.
  • Provides vendor oversight to design, propose, implement and administer solutions that increase claims payment accuracy and integrity.
  • Coordinate with Director of Payment Integrity for BCBSA Payment Integrity activities to include the following:
    • Serve a primary point of contact with BCBSA.
    • Acquire and maintain a strong understanding of BCBSA payment integrity requirements and ensure compliance.
    • Proactively monitor and provide updates regarding status of activities and escalate issues to leadership.
  • Oversee and manage staff for payment integrity activities.

    • Hire, train and direct staff.
    • Conduct performance reviews and mentor staff as needed in order to achieve expected results and/or professional development goals.
    • Provides feedback and coaching (helping individuals to solve problems/issues on their own)


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Equal Opportunity Employer - Minorities/Women/Protected Veterans/Disabled