Provider Reimbursement Manager
$80,940–$153,360 year
Hybrid · New York City, New York, United States or Atlanta, Georgia, United States
Job Summary
Provider Reimbursement Manager overseeing Medicaid prepay edit compliance and reimbursement strategies across multiple markets. Responsible for translating evolving state Medicaid guidelines into actionable prepay edit logic, onboarding new markets, maintaining centralized state-specific edit requirements, partnering with clinical, coding, analytics, and technology teams to operationalize edits, and ensuring alignment with enterprise prepay edit strategy. Role involves cross-functional collaboration to improve cost of care and medical loss ratio, with a hybrid in-office schedule (1-2 days/week) across listed locations. Requires a BA/BS and at least 7 years in reimbursement; preferred CPC/RHIT/RHIA certifications. Salary range for CA and NY locations: $80,940–$153,360 annually.
Required Qualifications
- BA/BS degree in a related field
- minimum of 7 years reimbursement experience
- experience with detailed financial modeling and economic analyses
- CPC/RHIT/RHIA certifications preferred
- deep knowledge of prepay editing and Medicaid guidelines
- experience onboarding Medicaid markets
- ability to influence across teams
- strong analytical and problem-solving skills
- experience interpreting state Medicaid guidelines
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