Payment Integrity Program Development Senior Manager – Clinical & Facility Specialist

📋 Description

• Identify new payment integrity opportunities across inpatient, outpatient, ASC, and professional
• Design automated payment logic translating policies into claims-edit rules.
• Validate concepts with real-world claims and data analyses.
• Lead cross-functional policy development with senior leaders and stakeholders.
• Own concepts from discovery to optimization across care settings.

🎯 Requirements

• Active RN license with inpatient clinical experience and CPC/CCS/CCS-P/RHIA coding cert.