Job Description
Are you an experienced leader with a keen eye for financial accuracy and clinical claims auditing? Virtual Staffing Solutions OPC is looking for a dedicated Payment Integrity Supervisor to join our team in Cebu City. In this pivotal role, you will lead our efforts to maximize cost-saving strategies within a high-paced TPA or insurance carrier environment.
As a supervisor, you will be responsible for overseeing the claims review process, identifying billing discrepancies, and implementing strategies to ensure accurate payment distributions. We are looking for a proactive professional who can mentor a team, drive performance metrics, and contribute to the overall operational efficiency of our payment integrity department. If you are passionate about reducing waste, preventing fraud, and ensuring regulatory compliance, we want to hear from you.
Responsibilities
- Oversee the daily operations of the payment integrity team, ensuring all claims are reviewed within established SLAs.
- Develop and implement robust audit strategies to identify and prevent overpayments, duplicate billings, and unauthorized charges.
- Conduct regular performance reviews and provide coaching to staff to ensure professional growth and technical proficiency.
- Maintain deep knowledge of current insurance industry standards, coding practices (ICD-10, CPT, HCPCS), and compliance regulations.
- Collaborate with cross-functional departments to resolve complex payment disputes and improve billing accuracy.
- Prepare detailed performance reports and trend analyses for stakeholders, highlighting key opportunities for cost-containment.
- Ensure that all team activities adhere strictly to HIPAA and other data privacy requirements.
Qualifications
- Bachelor’s degree in Healthcare Management, Finance, Business Administration, or a related field.
- At least 3-5 years of experience in payment integrity, claims auditing, or medical billing within a TPA or health insurance setting.
- Proven experience in a supervisory or team lead capacity.
- In-depth knowledge of medical coding, claims adjudication, and recovery workflows.
- Strong analytical skills with the ability to interpret financial data and identify recovery trends.
- Excellent communication skills with the ability to lead and motivate a diverse team.
- Proficiency in Microsoft Office Suite and specialized claims management software.
- Ability to work full-time on-site in Cebu City.