Quality Manager-Payment Integrity

Wellmark, Inc.
Cedar Rapids, IA
Category Insurance
Job Description
Wellmark is seeking a Quality Manager for Payment Integrity to lead an audit process for clinical and non-clinical work performed by the Payment Integrity team. The role focuses on auditing invoices, managing ASO audits, and developing procedures to ensure operational excellence. It involves collaboration with various departments to improve processes and ensure compliance.

Requirements

  • Active and Unrestricted Licensed Practical Nurse (LPN) or Registered Nurse (RN) license in Iowa or South Dakota (individual must be licensed in the state in which they reside).
  • Associate degree or direct and applicable work experience.
  • Coding certification (CPC, CPC-P, COC, CCS-P, RHIT, RHIA) (2+ years experience).
  • 4+ years of experience in payment integrity, SIU, insurance operations, coding, claim processing, contracting, credentialing, medical policy, or similar areas.
  • 2+ years of experience completing audits or coordinating audits.

Benefits

  • Competitive salary
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