Payment Accuracy Policy Manager (Remote) at Jobgether – Georgia

Payment Accuracy Policy Manager (Remote)

This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Payment Accuracy Policy Manager (Remote). In this role, you will play a vital role in bridging healthcare payment expertise with client strategy and product innovation. Your expertise will drive the development of payment integrity policies that not only protect our clients but also enhance platform capabilities. You will lead research and policy evaluation, translating complex payment policies into practical strategies that add significant value. This role offers the chance to significantly influence how health plans approach payment integrity, shaping the content foundation that supports our enterprise solutions.Accountabilities

• Source, interpret, and scope new payment integrity policies to expand the claims editing content library
• Prioritize policy updates based on savings potential, client impact, and strategic alignment with platform goals
• Leverage CMS, Medicaid, clinical guidelines, and industry trends to identify opportunities for new content development
• Quantify and communicate policy value through data-driven analysis and clear financial impact assessments
• Identify adoption gaps, implementation inefficiencies, and emerging opportunities within client programs
• Work closely with product and engineering teams to ensure client needs inform platform development
• Collaborate with content leadership to maintain consistency, quality, and relevance across the policy library
• Serve as the payment integrity expert across enterprise initiatives, providing consultative guidance to internal teams

Requirements

• 5-7 years of experience in payment integrity at a health plan, claims editing vendor, or similar healthcare organization
• Active coding certification (CPC, CCS, or equivalent specialty certification) required for this position
• Proven expertise in interpreting medical and payment policies
• Applying CMS and Medicaid reimbursement guidelines
• Professional and outpatient coding standards
• Common claims payment error identification and resolution
• Demonstrated ability to advise clients and explain complex payment accuracy concepts in clear, accessible terms
• Strong analytical skills with experience quantifying policy impact and ROI
• Track record of managing claims editing implementations or similar client-facing initiatives
• Expertise across both professional and institutional claims environments (preferred)

Benefits

• Flexible work environment with the opportunity for remote work
• Collaborative team culture that values input and innovation
• Opportunity to shape and influence key payment policies
• Professional development opportunities
• Engagement in cross-functional projects with diverse teams

Why Apply Through Jobgether? We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best!Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.#LI-CL1