Manager of Cost Avoidance

Job description

Overview Under the direction of the Associate Director of Internal Audit or above, the Cost AvoidanceManager is responsible for building, leading, and managing the HealthPlan’s Cost Avoidance andRecovery Teams. The purpose of the Cost Avoidance Team is to monitor payment of claims. Thepurpose of the Recovery Team is to identify overpayments for recovery; research and postprovider refund checks, monitor receivables in the Core System; identify, verify, and update CoreSystem with members’ other health insurance coverage information as required. Responsibilities: - Build the Cost Avoidance and Recoveries Teams. Generate job descriptions, recruit, train, and mentor highly motivated and qualified team members. - Work collaboratively with the Finance, Member Services, Provider Relations, Health Services, Configuration and Claims departments. - Lead the Cost Avoidance and Recoveries Teams to assess, develop, implement, and monitor activities related to cost savings and recoveries of medical claim payments. - Prioritize and delegate cost avoidance and recoveries tasks and projects. - Directly oversee the quality of work performed by the Cost Avoidance and Recoveries Team. - Ensure that the...