State Licensed Payment Accuracy Manager

Job Summary

A company is looking for a Payment Accuracy Manager, Outpatient Facility.

Key Responsibilities

• Lead the development of outpatient facility claims editing policies and research new payment integrity policies
• Quantify and communicate policy value through data-driven analysis and collaborate with product and engineering teams
• Investigate policy defects and unexpected claim outcomes, providing corrective actions to enhance policy accuracy

Required Qualifications

• 5-7 years of experience in payment integrity focused on outpatient facility claims editing
• Active coding certification (COC, CPC, CCS, or equivalent) is required
• Expertise in interpreting medical and payment policies and applying CMS and Medicaid guidelines
• Strong analytical skills with experience in quantifying policy impact and managing claims editing implementations
• Intermediate Excel skills, including formulas, v-lookups, and pivot tables