Manager Payment Integrity
About the position Blue Cross and Blue Shield of Kansas is looking to add to our Affordability team and has a new opportunity for a Manager, Payment Integrity. This position leads a team responsible for overseeing the daily operations that ensure accurate and compliant claims reimbursement. This includes validating billing and coding practices, member eligibility, and adherence to contractual and regulatory parameters. As a key enterprise subject matter expert (SME), the Manager will ensure all processes are efficient, compliant, and aligned with industry standards. The role requires strong leadership, strategic oversight of operational performance, and collaboration across multiple internal and external stakeholders. This position is eligible to work remotely (8 or less days a month onsite) or hybrid (9 or more days a month onsite) in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment. Responsibilities • Lead a team responsible for enterprise Payment Integrity operations, serving as the subject matter expert (SME) and guiding best practices across workflows and processes. • Provide direct leadership, coaching, and performance management to a team focused on claims accuracy, billing integrity, and operational compliance. • Ensure payment integrity functions comply with federal and state regulations, contractual, and operational standards. • Lead projects and implementations, focusing on scalable internal solutions and vendor engagements. • Utilize business intelligence and data analytics to monitor operations and identify cross-functional improvement opportunities. • Maintain and enhance payment integrity productivity, aligning operations with financial and quality targets. • Develop, implement, and maintain payment integrity policies and standard operating procedures (SOPs) to ensure consistency and compliance. • Collaborate with stakeholders across the enterprise to foster trust and effective working relationships. Requirements • Bachelors degree in health administration, Business, Finance or related field. • In lieu of degree, a minimum of 5 years of experience with 3+ years of leadership experience is required. • Minimum of 5 years of experience in payment integrity, claims management, or related functions within the health insurance industry. • Strong knowledge of healthcare regulations, payment integrity methodologies, and claims processing. • Proven experience managing projects, vendors, and cross-functional initiatives. • Proficiency in data analytics, business intelligence tools, and performance monitoring. • Excellent leadership, communication, and problem-solving skills. Benefits • Incentive pay program (EPIP) • Health/Vision/Dental insurance • 6 weeks paid parental leave for new mothers and fathers • Fertility/Adoption assistance • 2 weeks paid caregiver leave • 5% 401(k) plan matching • Tuition reimbursement • Health & fitness benefits, discounts and resources Apply tot his job