Payment Selections Manager

8 hours agoLeadSalary: 110K - 122KUnited States Remote Full Time Auditing Jobs by Flare Capital Partners

Skills

Payment Regulation Cpt Ccs Compliance Medicare Hcpcs Icd-10-Cm Claims Auditing Healthcare Payment Methodology Payment Integrity Icd-10 Healthcare Revenue Cycle Reimbursement Methodology Medical Policy Analysis Billing Regulations Certified Coding Data Analysis Microsoft Excel

About the Role

You'll join the Payment Integrity team as a player-coach who balances high-level strategy with hands-on technical execution. You'll research medical policies, billing regulations, and reimbursement logic to document new payment integrity concepts, then translate those complex billing rules into precise technical specifications for automated claim auditing algorithms. You'll perform expert-level claims auditing to validate improper payment scenarios before deployment, dig into datasets in Microsoft Excel to quantify savings potential for clients, and act as the primary liaison between your team, IT, and the Director of Payment Solutions. Along the way, you'll look for ways to improve internal processes and keep your expertise sharp in ICD-10, CPT, HCPCS, and payer reimbursement methodologies to ensure compliance.

Requirements

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

Responsibilities

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

Benefits

Medical, dental, vision, life, and disability insurance
Employee Assistance Program
401K retirement plan with company match
Flexible spending and health savings account
Flex Time Off + company holidays
Up to 14 weeks of paid parental leave
Pet insurance