Coding Review Principal

Job Summary

A company is looking for a Payment Integrity Principal - Coding Review.

Key Responsibilities

• Oversee the implementation of payment integrity logic across the platform, ensuring cohesive automation and AI capabilities
• Act as a senior subject matter expert, translating coding and reimbursement research into actionable logic for claim editing rules
• Analyze claims data to identify patterns and trends, supporting the development of payment integrity policies and initiatives

Required Qualifications

• Bachelor's degree in healthcare, business, information systems, data analytics, or a related field, or equivalent experience
• Active professional credential in Coding Review (CR), such as CPC, CCS, CCS-P, or RHIA
• 12+ years of experience in healthcare payment integrity, including Coding Review
• 7+ years of experience in analyzing and designing solutions to prevent improper payments