Opportunity Overview:

We are seeking a dynamic Payment Selections Manager to join our Payment Integrity team. In this role, you will drive the identification and recovery of improper claim payments, serving as a critical "player-coach" who balances high-level strategy with hands-on technical execution. You’ll partner closely with Data Science, IT, and Compliance teams to build innovative auditing algorithms, providing an opportunity to directly impact our payer clients' financial accuracy and operational excellence.

What you’ll do:

Research and document new payment integrity concepts by analyzing medical policies, billing regulations, and reimbursement logic.
Translate complex billing rules into precise technical specifications for automated claim auditing algorithms.
Perform expert-level claims auditing to validate potential improper payment scenarios and ensure accuracy before deployment.
Conduct hands-on data analysis using Microsoft Excel to explore datasets and quantify savings potential for clients.
Collaborate cross-functionally as the primary liaison between the team, IT, and the Director of Payment Solutions to align on project scopes and timelines.
Continuously identify opportunities to improve internal processes and workflows within the concept development lifecycle.
Ensure compliance by maintaining deep expertise in ICD-10, CPT, HCPCS, and payer reimbursement methodologies.

What you’ll need:

Must-haves

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).
Proficiency with Microsoft Excel (advanced level) and a strong understanding of healthcare revenue cycles.
Ability to balance individual technical contributions with managerial duties in a fast-paced environment.
Bachelor’s or Associate’s degree in Health Information Management, Health Informatics, or a related field.

Nice-to-haves

Dual Credentialing: Preference for candidates holding both a coding credential (CCS/CPC) and an HIM credential (RHIA/RHIT).
Advanced Experience in developing or specifying claim auditing algorithms and edits.
Familiarity with advanced data science platforms or IT implementation strategies.

Opportunity Overview:

What you’ll do:

Research and document new payment integrity concepts by analyzing medical policies, billing regulations, and reimbursement logic.
Translate complex billing rules into precise technical specifications for automated claim auditing algorithms.
Perform expert-level claims auditing to validate potential improper payment scenarios and ensure accuracy before deployment.
Conduct hands-on data analysis using Microsoft Excel to explore datasets and quantify savings potential for clients.
Collaborate cross-functionally as the primary liaison between the team, IT, and the Director of Payment Solutions to align on project scopes and timelines.
Continuously identify opportunities to improve internal processes and workflows within the concept development lifecycle.
Ensure compliance by maintaining deep expertise in ICD-10, CPT, HCPCS, and payer reimbursement methodologies.

What you’ll need:

Must-haves

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).
Proficiency with Microsoft Excel (advanced level) and a strong understanding of healthcare revenue cycles.
Ability to balance individual technical contributions with managerial duties in a fast-paced environment.
Bachelor’s or Associate’s degree in Health Information Management, Health Informatics, or a related field.

Nice-to-haves

Dual Credentialing: Preference for candidates holding both a coding credential (CCS/CPC) and an HIM credential (RHIA/RHIT).
Advanced Experience in developing or specifying claim auditing algorithms and edits.
Familiarity with advanced data science platforms or IT implementation strategies.

Payment Selections Manager

Payment Selections Manager

Cohere Health

Cohere Health

Benefits

Cohere Health