Payment Integrity Coding Manager

🕒 5 days ago

🌲 Oregon – Remote

🌲 Oregon – Remote

💵 $92.1k - $112.5k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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CareOregon

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1994

⚕️ Healthcare Insurance

🤝 Non-profit

Healthcare Insurance • Non-profit

CareOregon is a community-focused health plan that provides coordinated physical, behavioral, dental and social-support services to Oregon Health Plan members, serving more than 500,000 people. The organization operates provider and member portals, offers care coordination, telehealth, language and tribal services, community grants and outreach, and programs addressing social determinants of health such as housing, nutrition and transportation.

📋 Description

• Responsible for developing, implementing, and continuously improving enterprise-wide payment integrity and claims programs and strategies • Overseeing monitoring, analysis, and reporting of claims activity (e.g., trends, outliers, high-cost claims) • Managing development and maintenance of tracking mechanisms, dashboards, and documentation related to audits, findings, and overpayment recoveries • Ensure accurate invoicing and reconciliation for programs and vendors; oversee processing of recoupments and refunds • Identifying root causes of overpayments, track trends, and drive corrective actions with accountable owners • Building business cases and ROI models to expand initiatives, resources, and technology enabling sustainable savings and improved accuracy • Establish governance, KPIs, and reporting cadence for program performance, savings, recoveries, and risk mitigation • Leading a portfolio of coding audits, ensuring accurate capture of diagnosis and procedure codes in claims and chart review data • Developing and delivering training and education for providers and internal stakeholders

🎯 Requirements

• 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) • Preferred experience performing statistical claims analysis in a managed care or health care setting • Experience in and/or understanding of payment integrity programs and vendors • Experience with SQL Server Reporting, or using business intelligence tools (e.g., Tableau) and data framework

🏖️ Benefits

• medical, dental, vision, life, AD&D, and disability insurance • health savings account • flexible spending account(s) • lifestyle spending account • employee assistance program • wellness program • discounts • multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pet insurance) • retirement plan with employer contributions • PTO and Paid State Sick Time based on hours worked/scheduled hours • paid holidays, volunteer time, jury duty, bereavement leave