Payment Integrity Coding Manager

This is a fully remote position, open to applicants in Oregon.

📋 Description

• Accountable for the development, implementation, and ongoing enhancement of enterprise-wide payment integrity and claims initiatives and strategies.

• Supervising the monitoring, analysis, and reporting of claims activities (including trends, outliers, and high-cost claims).

• Overseeing the creation and upkeep of tracking systems, dashboards, and documentation pertaining to audits, findings, and recovery of overpayments.

• Ensuring precise invoicing and reconciliation for programs and vendors; managing the processing of recoupments and refunds.

• Identifying root causes of overpayments, tracking trends, and driving corrective actions with responsible stakeholders.

• Developing business cases and ROI models to promote initiatives, resources, and technologies that facilitate sustainable savings and enhanced accuracy.

• Establishing governance, KPIs, and reporting schedules for program performance, savings, recoveries, and risk management.

• Leading a portfolio of coding audits to guarantee accurate capture of diagnosis and procedure codes in claims and chart review data.

• Creating and providing training and education for providers and internal stakeholders.

⛳️ Requirements

• At least 5 years of management experience in health plan claims operations, auditing, and/or payment integrity.

• A minimum of 5 years of experience as a certified coder and/or Certified Coding Auditor with active certification from AHIMA or AAPC (such as CPC, CCS, CCA, CMC, or equivalent).

• Preferred experience in conducting statistical claims analysis within a managed care or healthcare environment.

• Familiarity with payment integrity programs and associated vendors.

• Proficient in SQL Server Reporting, or utilizing business intelligence tools (such as Tableau) and data frameworks.

🏝️ Benefits

• Medical, dental, vision, life, AD&D, and disability insurance.

• Health savings account.

• Flexible spending account(s).

• Lifestyle spending account.

• Employee assistance program.

• Wellness program.

• Discounts.

• Multiple supplemental benefits (including voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pet insurance).

• Retirement plan with employer contributions.

• PTO and Paid State Sick Time based on hours worked/scheduled hours.

• Paid holidays, volunteer time, jury duty, and bereavement leave.