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Payment Integrity Program Development Manager

πŸ“… Aug 5
Coding RegulationsBilling RegulationsData AnalyticsSQL

πŸ“œ Description

  • Manage the full lifecycle of edit and audit development from hypothesis to rule design.
  • Run data queries to validate coding and billing hypotheses and author technical specifications.
  • Design payment policies to ensure defensibility and anticipate provider disputes.
  • Continuously refine active rules based on real-world results and behavioral trends.
  • Collaborate with cross-functional teams to ensure compliance and strategic alignment.

πŸ› οΈ Requirements

  • Bachelor's degree and a minimum of 4 years of relevant experience in healthcare revenue cycle.
  • Expertise in coding and billing regulations, including CMS policies and NCCI bundling edits.
  • Experience in writing logic rules for claims processing implementation.
  • Strong problem-solving skills to clear operational obstacles and meet deadlines.
  • Ability to read and validate data query scripts or advanced spreadsheets.

✨ Benefits

  • Employer sponsored health, dental and vision plan with low or no premium.
  • Generous paid time off.
  • $100 monthly mobile or internet stipend.
  • Stock options for all employees.
  • Bonus eligibility for all roles excluding Director and above.
  • Parental leave program.
  • 401K program.
  • Convert complex medical policies and coding regulations into actionable logic specifications.
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