Supervisor, Payment Integrity – Appeals & Disputes

This is a fully remote position, open to applicants in Florida, +3 more states.

📋 Description

• Guide clinical coding compliance nurses and non-clinical team members through the process of code editing adjudication.

• Manage prepay compliance, adjustments, and appeals across various code editing software systems.

• Ensure that the Coding Analytics team adheres to production standards and successfully passes quality audits.

• Supervise relationships with health plans, Claims, and other departments.

• Identify and implement best practices along with operational efficiencies.

• Act as a liaison for health plan accounts and offer expertise on code editing decisions.

• Investigate coding-related questions and issues.

• Provide expert testimony during state fair hearings and to health plan leadership concerning state complaints from providers.

• Address and resolve escalated inquiries or issues from health plans, the Claims department, and providers.

• Facilitate communication among IT, health plans, vendors, and relevant departments.

• Carry out additional duties as assigned.

⛳️ Requirements

• Associate’s degree in Medical Billing and Coding, Healthcare, a related field, or equivalent experience.

• Over 5 years of experience in account management, nursing, healthcare management, medical billing, CPT coding, claims, coding analysis and trends, and/or data management.

• Experience with code editing software systems within a managed care organization is preferred.

• Current RN license in the state or Certified Professional Coder (CPC) certification is preferred.

• Adherence to all policies and standards is required.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase options.

• Tuition reimbursement opportunities.

• Paid time off in addition to holidays.

• Flexible work arrangements including remote, hybrid, field, or office schedules.

• Additional incentive programs may be included in the total compensation package.