Responsibilities Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience.
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Job Summary: The Payment Integrity Program Lead will ensure that claims are paid accurately through Coordination of Benefit (COB) processing using secondary insurance coverage information. This position is directly responsible for researching and maintaining coordination of benefits of all contracted and non-contracted health plan entities as reported by multiple sources. This role will investigate and analyze Medicare Secondary Payer (MSP) demands for coordination of benefits with Medicare. The individual reviews cases to determine primary liability when not established. Maintains system information regarding coverage overlaps and primacy to ensure correct coordination occurs with Medicare. Research claims history to identify previously paid claims for recovery.
Benefit Highlights: Loan Forgiveness Program Challenging and rewarding work environment Competitive Compensation & Generous Paid Time Off Excellent Medical, Dental, Vision and Prescription Drug Plans 401(K) with company match and discounted stock plan SoFi Student Loan Refinancing Program Career development opportunities within UHS and its 300+ Subsidiaries! · More information is available on our Benefits Guest Website: benefits.uhsguest.com About Universal Health Services: One of the nation's largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World's Most Admired Companies by Fortune; and listed in Forbes ranking of America's Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom.
Qualifications Qualification and Requirements: Bachelor's degree preferred Advanced SQL skills to aid in identification of cases to be worked Experience in Medicare Secondary Payment/Coordination of Benefits 3-5 years of experience with Medicare Advantage Health Plan Knowledge of HMO, PPO, EPO, POS, Government Funded, Medicare and Medicaid plans Knowledge of the Department of Managed Healthcare COB guidelines Excellent customer service skills and ability to drive resolution of complex cases involving internal and external stakeholders Understanding of medical benefits, plan structure, and member eligibility Program and Project Management skillset Capable interpersonal skills to easily establish rapport with provider office staff Self-starter with an ability to work autonomously, managing own workload to drive results Highly organized with attention to detail Demonstrated ability to follow through on project work Microsoft Office proficient (Excel, Word, Outlook) and/or Smartsheet Performs other duties as assigned or required EEO Statement All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.
We believe that diversity and inclusion among our teammates is critical to our success.
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If you would like to learn more about the opportunity, please contact Bridget Gomez at:
