Payment Selections Manager in United States at Jobgether
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Job Description
This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Payment Selections Manager based in the United States.
This role sits at the intersection of healthcare payment integrity, clinical coding expertise, and data-driven financial accuracy, focusing on identifying and recovering improper claim payments. You will operate in a hybrid “player-coach” capacity, combining hands-on technical claims auditing with strategic concept development for automated auditing algorithms. The position involves close collaboration with Data Science, IT, and Compliance teams to translate complex reimbursement rules into actionable technical specifications. You will play a key role in shaping how payment integrity concepts are designed, validated, and deployed at scale. The environment is highly analytical and mission-driven, with a strong focus on precision, healthcare economics, and continuous improvement. Your work will directly influence payer accuracy, cost containment, and overall system integrity across healthcare transactions.
- Lead the identification, design, and documentation of payment integrity concepts by analyzing medical policies, billing regulations, and reimbursement methodologies to detect improper claim payments
- Translate complex coding rules (ICD-10, CPT, HCPCS) and payer logic into clear technical specifications for automated claim auditing algorithms and validation systems
- Perform advanced, hands-on claims auditing and data analysis using Excel and related tools to validate findings, quantify financial impact, and assess savings potential
- Partner cross-functionally with Data Science, IT, Compliance, and leadership to define project scope, align on requirements, and support development of auditing solutions
- Serve as a subject matter expert in payment integrity workflows, ensuring accuracy, compliance, and readiness of audit logic prior to deployment
- Continuously improve concept development processes by identifying inefficiencies and enhancing workflows, documentation standards, and analytical approaches
- 8+ years of experience in claims auditing, payment integrity, healthcare data analysis, or related healthcare revenue cycle functions
- Strong expertise within payer or healthcare environments, with deep understanding of reimbursement methodologies and claims processing systems
- Active coding credential such as CPC, CCS, RHIA, or RHIT, with strong applied knowledge of medical coding standards and compliance frameworks
- Advanced proficiency in Microsoft Excel, including large dataset analysis, pivot tables, and financial modeling for claims and savings evaluation
- Experience balancing individual technical contributions with broader coordination or leadership responsibilities in fast-paced environments
- Strong analytical, problem-solving, and critical thinking skills with the ability to independently validate complex claims scenarios
- Excellent communication skills with the ability to collaborate across technical, clinical, and operational stakeholders
- Competitive annual salary range of $110,000 to $122,000, with eligibility for bonus and additional compensation components
- Fully remote work environment with limited travel requirements
- Comprehensive health benefits including medical, dental, vision, life, and disability insurance coverage
- 401(k) retirement plan with company matching contributions
- Flexible time off policy and paid company holidays
- Paid parental leave and family support programs
- Flexible spending accounts and health savings account options
- Additional perks including employee assistance programs and optional pet insurance
- Opportunity to work in a mission-driven healthcare technology environment focused on improving payment accuracy and care outcomes