Payment Integrity Concept Development SME
About The Position
The Subject Matter Expert (SME) – Payment Integrity Concept Development is responsible for designing, developing, and validating innovative payment integrity concepts that identify inaccurate, inappropriate, or unsupported healthcare claims. This individual combines deep expertise in medical coding, reimbursement methodologies, clinical documentation, regulatory guidance, and claims analytics to develop high-value overpayment detection opportunities that generate measurable savings. The ideal candidate has a proven history of successfully developing new payment integrity concepts from initial idea through implementation, resulting in significant financial recoveries while maintaining high clinical accuracy and low provider abrasion.
Requirements
- Deep expertise in medical coding.
- Deep expertise in reimbursement methodologies.
- Deep expertise in clinical documentation.
- Deep expertise in regulatory guidance.
- Deep expertise in claims analytics.
- Proven history of successfully developing new payment integrity concepts from initial idea through implementation.
Responsibilities
- Designing, developing, and validating innovative payment integrity concepts.
- Identifying inaccurate, inappropriate, or unsupported healthcare claims.
- Developing high-value overpayment detection opportunities that generate measurable savings.
- Successfully developing new payment integrity concepts from initial idea through implementation.
- Achieving significant financial recoveries while maintaining high clinical accuracy and low provider abrasion.
Benefits
- Base Pay Range: $75,100 - $107,300/yr
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
No Education Listed
