Clinical Content and Editing Reimbursement Manager

Responsibilities 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 Qualifications 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 preferredDemonstrated ability to lead cross-functional initiatives Scaled Agile Framework (SAFe) experience preferred. #J-18808-Ljbffr Jobtailor