Code Edit Professional, Payment Integrity in New York at Jobgether

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Code Edit Professional, Payment Integrity based in the United States.

This remote role offers an opportunity to support payment integrity initiatives that help improve claims accuracy and reduce healthcare costs. You’ll work across code editing processes, vendor platforms, claims systems, and data to help ensure effective payment integrity operations. The position combines stakeholder collaboration, data analysis, process management, and problem-solving in a fast-paced, metrics-driven environment. You’ll contribute to new code edit reviews, testing, implementation, and ongoing maintenance while helping resolve complex stakeholder inquiries. The role also provides opportunities to improve processes and strengthen collaboration with internal teams and external vendors. It’s well suited to an analytical professional who is detail-oriented, adaptable, and comfortable managing multiple priorities independently.

• Build and maintain effective relationships with internal stakeholders and external code editing vendors.
• Support the review, testing, implementation, and ongoing maintenance of new claims code edits.
• Utilize vendor platforms, claims processing systems, and data to support payment integrity initiatives and claims cost reduction.
• Manage and resolve inquiries from stakeholders related to code editing processes and functionality.
• Collaborate with business partners to identify opportunities for process improvement and ensure successful day-to-day operations.
• Facilitate meetings with internal and external stakeholders and communicate findings, recommendations, and project updates effectively.
• Analyze claims and other relevant data to support research, decision-making, and payment integrity activities.
• Manage multiple priorities and transition efficiently between tasks based on business urgency and operational needs.
• Support projects and processes related to code editing, including specialized vendor tools and rule creation when applicable.
• Maintain confidentiality and uphold professional and ethical standards when working with sensitive information, including protected health information.
• Contribute to initiatives focused on improving consumer experiences and operational effectiveness.

• Demonstrated experience managing relationships with clients, vendors, and/or other external partners.
• Experience facilitating meetings and collaborating with internal and external stakeholders.
• Experience with data analysis and/or research.
• Strong analytical thinking, problem-solving, and decision-making skills, including the ability to develop creative solutions.
• Ability to manage diverse priorities in a dynamic, fast-changing environment with minimal supervision.
• Strong attention to detail and ability to operate effectively in a fast-paced, agile, metrics-driven setting.
• Excellent verbal and written communication skills.
• Ability to work effectively both independently and as part of a collaborative team.
• Working knowledge of Microsoft Word, SharePoint, and Excel.
• Strong commitment to ethical standards, professional integrity, and confidentiality.
• Passion for contributing to initiatives that continuously improve consumer experiences.
• Prior experience using code editing vendor tools is strongly preferred.
• Advanced Excel skills, including HLOOKUPs, VLOOKUPs, pivot tables, and similar functionality, are strongly preferred.
• Experience working with external vendors and/or internal stakeholders is preferred.
• Experience with healthcare claims processes and medical claims data analysis is preferred.
• Familiarity with PowerPoint and OneNote is preferred.
• Experience with THOR rule creation and/or related processes is preferred.
• Prior experience leading projects or operational processes is preferred.

• Fully remote, work-from-home position available nationwide.
• Full-time schedule of 40 hours per week, Monday through Friday, generally 8 hours per day within the employee’s time zone.
• Base salary range of $65,000–$88,600 per year, depending on location, skills, experience, education, certifications, and other job-related factors.
• Eligibility for a bonus incentive plan based on organizational and/or individual performance.
• Medical, dental, and vision coverage.
• 401(k) retirement savings plan.
• Paid time off, company holidays, and personal holidays.
• Paid parental and caregiver leave.
• Short-term and long-term disability coverage.
• Life insurance and additional employee benefits supporting health, wellness, and financial well-being.
• Minimal occasional travel, approximately 1–2 times per year for training, meetings, or conferences.
• Flexible scheduling may be required to accommodate business needs.
• Home internet service must support at least 25 Mbps download and 10 Mbps upload speeds; wireless, wired cable, or DSL connections are suggested.
• Employees in California, Illinois, Montana, or South Dakota may receive a bi-weekly payment toward eligible internet expenses.
• Appropriate telephone equipment is provided to support business requirements.
• A dedicated, interruption-free workspace is required to protect confidential member and healthcare information.