Managing development and execution of clinical content and provider reimbursement strategies
Leading development for specific plans and clinical editing rules
Preparing and presenting reimbursement, coding, payment integrity, and cost-of-care analyses
Collaborating with Clinical Content, Engineering, Product, and Data teams
Researching and interpreting CMS regulations and industry references
Overseeing validation activities to confirm reimbursement methodologies
Managing special projects and continuous improvement efforts

Requires BA/BS degree in related field
Minimum of 7 years reimbursement experience, including detailed financial modeling and economic analyses
5+ years of claims editing, payment integrity, or clinical content development experience preferred
Expertise in billing, coding, revenue cycle, and claims adjudication preferred
Nationally recognized coding or billing credential (CCS, CCS-P, CPC, CPB, or CIC)
Strong analytical and problem-solving skills
Intermediate proficiency with Microsoft Excel (including PivotTables, VLOOKUP/XLOOKUP)
SQL query and data validation experience preferred
Demonstrated ability to lead cross-functional initiatives
Scaled Agile Framework (SAFe) experience preferred.

Clinical Content and Editing Reimbursement Manager

Key skills