Payment Integrity Coding Manager
$92,070–$112,530 year
Remote · Oregon, United States
Job Summary
Payment Integrity Coding Manager responsible for developing, implementing, and continuously improving enterprise-wide payment integrity and coding programs. Leads coding audits (prospective and retrospective), RADV, training for providers/internal stakeholders, and quality/testing initiatives; oversees UAT for system changes impacting claims and coding; partners with vendors, Legal, Audit, Compliance, Finance, Data Analytics, Network Operations, Provider Relations, and Clinical Operations to drive accurate payments, mitigate risk, and optimize recoveries. Requires living in Oregon or within 50 miles of downtown Portland. Strong leadership, project management, and analytics skills with expertise in ICD-10-CM/PCS, CPT/HCPCS, AMA/CMS guidelines, and health plan operations.
Required Qualifications
- Minimum 5 years’ management experience in health plan claims operations, audit, and/or payment integrity
- Minimum 5 years’ experience as a certified coder and/or Certified Coding auditor with active certification AHIMA or AAPC (e.g., CPC, CCS, CCA, CMC or equivalent)
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