Provider Education Program Manager - Payment Integrity
$107,901–$172,642 year
Remote · Durham, North Carolina, United States or Arizona, United States
Job Summary
Provider Education Program Manager responsible for designing, implementing, and managing a health plan provider education program focused on coding, documentation, and billing integrity, including identifying upcoding and aberrant patterns, developing outreach and education letters, conducting provider outreach calls, and coordinating with SIU and Compliance; requires program development oversight, data analysis of claims and reimbursement data, creation of standardized processes, and monitoring to assess behavior change, with opportunities for cross-functional collaboration and a Hybrid-Flex work arrangement; compensation includes base salary within the stated range and comprehensive benefits.
Required Qualifications
- Bachelor's degree or advanced degree (where required)
- 8+ years of experience in related field
- Experience with CPT, HCPCS, ICD-10, modifiers, documentation standards, reimbursement methodology
- Experience in managed care, Medicare, Medicaid, Marketplace, or commercial health plan operations
- Experience with provider education, payment integrity vendor outputs, post-pay review, overpayment recovery, or FWA/SIU workflows
- Advanced Excel, dashboarding, and data visualization skills
- Strong knowledge of CPT, HCPCS, ICD-10, modifiers, documentation standards, reimbursement methodology, CMS guidance, and payer billing requirements
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