Claims Payment Policy Lead

Job Summary

To support the development and execution of medical and claim payment policies, the remote contract-to-hire Claims Payment Policy Lead will manage collaborations with clinical and business teams, oversee policy maintenance, and monitor reimbursement trends to ensure compliance and cost efficiency.

Key responsibilities

• Lead collaboration with clinical, coding, and business stakeholders to implement policy-driven medical cost savings initiatives
• Oversee the development and maintenance of medical and claim payment policies aligned with reimbursement standards and regulatory requirements
• Monitor reimbursement trends and regulatory updates to ensure policies remain compliant and cost-effective

Required qualifications

• Bachelor's degree in a related field or equivalent professional experience in healthcare reimbursement or policy functions
• Active coding certification (CCS, CPC, RHIA, or RHIT) with clinical licensure (RN) considered a strong asset
• At least five years of experience in revenue cycle operations, including application of CPT, HCPCS, and ICD-10 coding standards
• Solid understanding of healthcare reimbursement models, payer operations, and regulatory guidance
• Strong analytical and organizational skills with the ability to manage priorities and lead cross-functional collaboration