Senior Manager, Payment Integrity

Job Summary

Managing a team of Payment Integrity disputes and appeals delivery, the full-time Senior Manager, Payment Integrity will oversee operations, ensure compliance with service level agreements, and drive data-driven analyses to enhance provider relationships in a remote setting.

Key responsibilities

• Direct and mentor the Payment Integrity team to manage daily queue health, turnaround times, and quality assurance
• Serve as the Subject Matter Expert on billing guidelines and CMS regulations, providing escalation support for complex claims
• Conduct root-cause analyses on dispute data to identify trends and recommend process improvements to reduce future disputes

Required qualifications

• 5+ years of experience in healthcare payment integrity and dispute management
• 3+ years of supervisory or people management experience
• Extensive knowledge of CMS regulations and coding guidelines (CPT, HCPCS, ICD-10)
• Strong analytical skills with experience in synthesizing claims data and identifying systematic gaps
• Exceptional collaboration skills with a proven track record of aligning processes across various teams