Payment Selections Manager

Opportunity Overview:

• Drive the identification and recovery of improper claim payments.
• Partner closely with Data Science, IT, and Compliance teams to build innovative auditing algorithms.
• Directly impact our payer clients' financial accuracy and operational excellence.

What you’ll do:

• Perform expert-level claims auditing to validate potential improper payment scenarios and ensure accuracy before deployment.
• Ensure compliance by maintaining deep expertise in ICD-10, CPT, HCPCS, and payer reimbursement methodologies.
• Continuously identify opportunities to improve internal processes and workflows within the concept development lifecycle.

What you’ll need:

• 8+ years of experience in claims auditing, data analysis, or payment integrity concept design.
• Demonstrated expertise within a healthcare or payer environment.
• An active certified coder credential (e.g., CPC, CCS, RHIA, or RHIT).