Job Description

Job Description

Job Summary

We are partnered with an excellent organization that is seeking a skilled Project Manager to lead strategic and operational payment integrity initiatives . This role requires a proactive, detail-oriented professional who can successfully manage projects in a highly regulated environment. The Project Manager will oversee:

1. Healthcare business projects, including DRG validation, cost outlier analysis, and readmission reviews, as well as the integration of technology solutions to support these functions.
2. Cross-functional teams, project timelines, and deployments, while serving as a liaison between technical resources and business operations.

📌 This is an in-office position Monday through Thursday, with remote work on Fridays.

Key Responsibilities

• Project Management: Plan, execute, monitor, and close healthcare-related projects.
• Team Coordination: Partner with internal teams (IT, business operations) and external vendors to ensure seamless execution.
• Requirements Gathering: Collaborate with stakeholders to define project scope, requirements, milestones, and resources.
• Scheduling & Budget Management: Develop project schedules, monitor progress, track budgets, and ensure timely delivery.
• Risk & Issue Management: Identify risks, create mitigation strategies, and escalate issues when necessary.
• Communication: Provide clear, consistent updates to stakeholders and leadership; maintain accurate documentation and reports.
• Quality & Compliance: Ensure all project deliverables meet healthcare regulations (HIPAA/HITRUST), IT security standards, and internal quality benchmarks.
• Tracking & Documentation: Maintain detailed records to ensure compliance with HITRUST and other regulatory frameworks.

Required Skills & Qualifications

• 4+ years of experience in healthcare project management, with at least 2 years in DRG validation, hospital bill audits, or claims adjudication.
• Strong knowledge of healthcare compliance standards including HITRUST, HIPAA, and HITECH.
• Proficiency in MS Project, Excel (pivot tables, VLOOKUPs), Word, and PowerPoint; Power BI experience a plus.
• In-depth understanding of ICD-10 coding and healthcare audit practices.
• Excellent communication skills with the ability to convey technical information to non-technical audiences.
• Strong organizational skills with the ability to manage competing priorities and influence cross-functional teams.

Education & Training

• Bachelor’s degree in Health Information Management, Healthcare Administration, or a related field (or equivalent experience).
• Familiarity with payment integrity, claims adjudication, or healthcare fraud/waste/abuse prevention.
• Technical aptitude to bridge business needs with IT solutions in a fast-paced, collaborative environment.

Job Tags

Similar Jobs