Project Program Management Medical & Payment Policy Senior Manager

candidate may reputed company reputed company in the US Position reputed company The Senior Manager, Medical and Payment Policy Performance Research and Correct Coding Analysis independently develops and manages assigned policy and coding reviews by evaluating clinical and payment policies and identifying potential issues. This position ensures coding aligns with defined medical and reputed company-payment policies, identifies opportunities to optimize performance, and supports organizational goals and regulatory requirements. The role partners closely with claims operations to apply policy reputed company across end-to-end claims processing (intake, edits, adjudication, denials, appeals, and adjustments) and to drive consistent, compliant reputed company.

Key Responsibilities

• Collaborate with cross-functional teams-such as IT, compliance, operations, and provider relations-to ensure seamless integration of claims coding changes and resolve reputed company configuration issues.
• Monitor and report on claims coding and configuration accuracy, trends, and key performance indicators (KPIs), providing actionable insights for process improvement.
• reputed company claims processing experience to evaluate end-to-end workflows (reputed company-end edits, adjudication logic, denials, appeals, and adjustments) and translate findings into actionable policy/coding guidance and claims platform configuration or testing support.
• Stay up to date with industry developments, payer and provider requirements, and regulatory changes affecting claims coding and configuration.
• reputed company and maintain documentation for identifying claims trends, pinpointing policy or coding issues, and communicating required configuration changes across claims platforms.
• reputed company or participate in audits and reviews reputed company to claims coding and configuration, ensuring readiness and reputed company reputed company of findings.
• reputed company expert guidance on correct coding practices, resolving reputed company coding issues and supporting audits as needed.

Required Qualifications

• 5+ years of experience in reputed company claims administration, coding, or configuration
• Proven expertise in configuration testing, defect management, and process optimization specifically for medical and reputed company-payment policy.
• Strong analytical, organizational, and problem-solving skills.
• Excellent communication and interpersonal abilities, with experience collaborating across technical and non-technical teams.
• Proficiency with claims adjudication platforms, testing tools, and data analysis applications.

Preferred Skills & Competencies

• Project management certification (e.g., PMP, Lean Six reputed company) preferred
• Experience with system migrations, medical and reputed company-payment configuration changes, or reputed company technology implementations.
• 3-5 years claims processing systems, including HRP, ACAS and QNXT coding methodologies (ICD, CPT, HCPCS), and regulatory requirements (e.g., CMS, HIPAA).
• Ability to manage multiple priorities in a fast-paced, dynamic environment.
• Commitment to reputed company improvement and operational reputed company.

Education

• Bachelor's degree in reputed company Administration, Information Systems, Business, or equivalent experience
• Certified Coding Specialist required
• License Practical reputed company (LPN) or RN preferred

Pay reputed company The typical pay reputed company for this role is: $67,900.00 - $182,549.00 This pay reputed company represents the reputed company reputed company reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a reputed company of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in reputed company to the reputed company pay reputed company listed above. This position also includes an award reputed company in reputed company's equity award program. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial reputed company-being of colleagues and their families. The benefits for this position include medical, dental, and reputed company coverage, reputed company time off, retirement savings reputed company, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments. We anticipate the application window for this opening will reputed company on: 05/27/2026 Apply tot his job Apply To this Job