Payment Integrity Senior Manager

Job Summary

As a senior payment integrity subject matter expert, the full-time remote Payment Integrity Program Development Senior Manager will manage and optimize internal and vendor-supported payment integrity programs, ensuring accurate and efficient claims processing while collaborating with cross-functional teams on complex initiatives.

Key responsibilities

• Manage assigned payment integrity programs, overseeing implementation, monitoring, and operational support
• Evaluate program performance to identify trends, emerging risks, and opportunities for improvement
• Conduct complex root cause analysis and develop evidence-based recommendations for issue resolution

Required qualifications

• Bachelor's degree and a minimum of 6 years of relevant professional experience in healthcare payment operations
• Strong expertise in healthcare claims, payment integrity, and claims editing
• Demonstrated experience in implementing and optimizing payment integrity programs
• Ability to independently investigate complex claims issues and perform root cause analysis
• Strong analytical skills to interpret claims data and operational metrics