Integra Partners Benefits Overview

Supports clinical utilization management teams with administrative processing of prior authorizations and appeals. Responsibilities include entering authorization requests, verifying eligibility and documentation, contacting providers, issuing notifications, completing verbal notifications, initiating appeals, documenting cases, and meeting regulatory deadlines. Requires knowledge of ICD-10, HCPCS codes, medical terminology, managed care processes, and strong organizational and communication skills.

Manages the corporate compliance program for payer services, including audits, fraud, waste and abuse investigations, compliance training, licensing, policy updates, risk assessments, and regulatory research. Partners with health plans, DME providers, internal teams, legal, and data security staff to address compliance and security concerns. Oversees a compliance analyst and supports HIPAA, CMS, Medicare, Medicaid, credentialing, and healthcare regulatory obligations.

Leads complex post-sale health plan implementations from kickoff through launch, stabilization, and operational handoff. Owns project plans, client relationships, cross-functional coordination, risks, decisions, testing, claims workflow validation, issue resolution, readiness, documentation, and executive reporting. The role requires direct payer implementation and healthcare claims experience, strong facilitation and communication skills, and the ability to drive accountability across teams. It also mentors junior staff and improves implementation processes, templates, and standards.