Job Description

Job Description

Job Description

Position Overview:
We are seeking an experienced Project Manager to lead strategic and operational payment integrity initiatives within our healthcare organization. The ideal candidate embodies a proactive, detail-oriented approach to driving project success in a regulated environment and is responsible for managing:
Business projects related to healthcare initiatives (DRG validation, Cost outlier, readmission reviews), and the integration of technology solutions that support these functions.
Cross-functional teams, project timelines, ensuring efficient deployments, and bridging the gap between technical resources, and business operations.
Please be advised that position is in-office Monday to Thursday and remote on Friday.


Responsibilities:

 

• Project Management: Tactically plan, execute, monitor, and close all projects particularly those involving healthcare
• Team Coordination: Collaborate with internal teams (IT, Business operations) and external vendors to ensure effective project execution

• Requirements Gathering: Work with stakeholders to define scope, requirements, milestones, and resource needs for each project
• Scheduling & Budget Tracking: Develop project schedules, track progress, monitor budgets, and manage timelines
• Risk & Issue Management: Identify risks and develop mitigation strategies. Escalate issues appropriately to senior leadership or technical teams
• Communication: Provide regular updates to project sponsors, stakeholders, and team members. Maintain clear documentation and status reports
• Quality & Compliance: Ensure project outcomes comply with healthcare regulations (HIPAA/HITRUST), IT security policies, and internal quality standards
• Tracking & Documentation: Monitor all application schedules and document requirements to assure regulatory compliance with HITRUST standards (Privacy framework used by multiple industries to provide data security)

• 4+ years’ experience in healthcare project management, and 2+ years’ experience with DRG validation, hospital bill audits, or claims adjudication reviews.
• Knowledge of HITRUST, HIPAA, HITECH, and general compliance standards in healthcare/IT.
• Proficiency with MS Project, MS Excel (pivot tables, v-lookups), MS Office suite (Excel, Power Point, Word) for documentation/presentations and familiarity with Power BI is a plus.
• Deep understanding of ICD-10 coding and healthcare audit practices.
• Strong interpersonal skills and ability to communicate effectively both orally and in writing.
• Ability to manage competing priorities and influence cross-functional teams.
• Organizational and time management skills to keep teams and projects on schedule.

• Bachelor’s degree or equivalent experience in health information management, healthcare administration or related field.
• Familiarity with payment integrity, claims adjudication, or healthcare fraud/waste/abuse prevention.
• Baseline technical knowledge whereby complex technical information is translated for non-technical stakeholders and business goals for technical teams.
• Comfortable in a fast-paced healthcare and IT environment requiring adaptability and cross-team collaboration.

• Healthcare that fits your needs - We offer excellent medical, dental, and vision plan options that provide coverage to employees and dependents.
• 401(k) with Employer Match - Join the team and we will invest in your future
• Generous Paid Time Off - Accrued PTO starting day one, plus additional days off when you’re not feeling well, and 11 observed holidays.
• Wellness - We care about your well-being. From Commuter Benefits to FSAs we’ve got you covered.
• Learning & Development - Through continued education/mentorship on the job and our investment in LinkedIn Learning, we’re focused on your growth as a working professional.

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