Payment Selections Manager
New
United StatesFull-TimeManager
Salary110,000 - 122,000 USD per year
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Job Details
- Experience
- 8+ years
- Required Skills
- Data AnalysisMicrosoft Excel
Requirements
- 8+ years of experience in claims auditing, data analysis, or payment integrity concept development within a healthcare or payer environment
- Active certified coding credential (CPC, CCS, RHIA, or RHIT) required
- Strong understanding of healthcare revenue cycles and payer reimbursement methodologies
- Advanced proficiency in Microsoft Excel, including data analysis, modeling, and reconciliation
- Experience translating healthcare policies and billing rules into structured operational or technical requirements
- Strong analytical, problem-solving, and investigative mindset with attention to detail
- Ability to balance independent technical execution with cross-functional collaboration in a fast-paced environment
- Bachelor’s or Associate’s degree in Health Information Management, Health Informatics, or related field preferred
Responsibilities
- Research and document new payment integrity opportunities by analyzing medical policies, billing regulations, and reimbursement methodologies
- Translate complex healthcare billing rules into clear technical specifications for automated claims auditing systems
- Perform expert-level claims auditing to validate payment accuracy and support algorithm development prior to deployment
- Conduct detailed data analysis using Excel to assess claims patterns, quantify savings, and identify risk areas
- Partner with IT, Data Science, Compliance, and leadership to define project scope, align priorities, and ensure timely execution
- Maintain and apply deep expertise in ICD-10, CPT, HCPCS, and payer reimbursement guidelines to ensure regulatory compliance
- Identify and implement process improvements across the concept development and payment integrity lifecycle
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