Payment Selections Manager

Job Description

• This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Payment Selections Manager in the United States. This role sits at the intersection of healthcare payment integrity, data analysis, and clinical coding expertise, driving the identification and recovery of improper claim payments. You will act as both a strategic thinker and hands-on expert, translating complex reimbursement rules into structured technical specifications used to build automated auditing logic. Working within a highly cross-functional environment, you will collaborate closely with data science, IT, and compliance teams to improve payment accuracy and operational efficiency. The position blends analytical depth with regulatory expertise, requiring strong command of medical coding standards and healthcare billing systems. You will also validate auditing logic through hands-on claims review and data analysis before deployment. This is a high-impact role where your work directly improves financial integrity across healthcare payment systems.
• Accountabilities: In this role, you will lead the development, validation, and execution of payment integrity concepts that ensure accurate healthcare reimbursements and reduce improper payments: Research and document new payment integrity opportunities by analyzing medical policies, billing regulations, and reimbursement methodologies Translate complex healthcare billing rules into clear technical specifications for automated claims auditing systems Perform expert-level claims auditing to validate payment accuracy and support algorithm development prior to deployment Conduct detailed data analysis using Excel to assess claims patterns, quantify savings, and identify risk areas Partner with IT, Data Science, Compliance, and leadership to define project scope, align priorities, and ensure timely execution Maintain and apply deep expertise in ICD-10, CPT, HCPCS, and payer reimbursement guidelines to ensure regulatory compliance Identify and implement process improvements across the concept development and payment integrity lifecycle Requirements: This role requires deep healthcare industry expertise, strong analytical capability, and hands-on experience in claims auditing or payment integrity: 8+ years of experience in claims auditing, data analysis, or payment integrity concept development within a healthcare or payer environment Active certified coding credential (CPC, CCS, RHIA, or RHIT) required Strong understanding of healthcare revenue cycles and payer reimbursement methodologies Advanced proficiency in Microsoft Excel, including data analysis, modeling, and reconciliation Experience translating healthcare policies and billing rules into structured operational or technical requirements Strong analytical, problem-solving, and investigative mindset with attention to detail Ability to balance independent technical execution with cross-functional collaboration in a fast-paced environment Bachelor’s or Associate’s degree in Health Information Management, Health Informatics, or related field preferred Benefits: Remote-first role within the United States Salary range of $110,000 to $122,000 annually, plus bonus eligibility Comprehensive medical, dental, vision, life, and disability insurance 401(k) retirement plan with company match Flexible spending and health savings accounts (FSA/HSA) Generous paid time off and company holidays Up to 14 weeks of paid parental leave Employee assistance program (EAP) for mental health and wellbeing support Pet insurance coverage Flexible, impact-driven work environment focused on healthcare innovation and collaboration
• How Jobgether works: We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best! Why Apply Through Jobgether? Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time. #LI-CL1
• We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.
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