Lead Payment Policy Manager - Remote
About The Position
This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Payment Policy Manager - REMOTE. In this vital role, you will develop, implement, and manage payment policies and strategies that optimize revenue while ensuring compliance with federal, state, and payer-specific guidelines. You will analyze regulatory changes and reimbursement models to support the organization's financial performance and collaborate closely with clinical, financial, and revenue cycle teams. This is an opportunity to significantly impact patient care and operational efficiency in a remote work setting.
Requirements
- Bachelor's Degree required.
- Certified Professional Coder (CPC) highly preferred.
- 5-7 years of experience in payment policy management or healthcare finance.
- 1-2 years of leadership or supervisory experience.
- Experience with claims editing and ClaimsXten system is highly preferred.
- Ability to prioritize work and operate under tight deadlines.
- Strong aptitude for technology-based solutions.
- Experience in policy development and contract management.
Nice To Haves
- Certified Professional Coder (CPC) highly preferred.
- Experience with claims editing and ClaimsXten system is highly preferred.
- Quarterly onsite meetings (preferred, not required).
Responsibilities
- Evaluate and align ClaimsXten/CCI configuration with approved business requirements and payment policies.
- Lead discussions regarding coding, configuration, and claims adjudication using your claims experience.
- Support and enhance ClaimsXten documentation in the Claim Editing Repository.
- Research and create documentation on medical billing and coding rules.
- Stay updated with CMS coding regulations and develop documentation for PPGs.
- Publish recommendations to senior leadership on coding rules and payment policies.
- Draft new and revised written provider payment guidelines.
- Coordinate publishing and distribution of finalized PPGs.
- Participate in cross-functional teams to present findings on medical coding issues.
- Serve as a subject matter expert on payment policies for corporate projects.
Benefits
- Competitive salary range of $62,400.00 - $90,750.40 annually.
- Comprehensive benefits package.
- Career advancement opportunities.
- Flexible remote work environment.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Number of Employees
11-50 employees
