Supervisor, Payment Integrity - Appeals & Disputes
Core
Lead clinical coding compliance nurses and non-clinical team members through the code editing adjudication process, including prepay compliance, adjustments, and appeals for multiple code editing software systems.
Role type
Senior IC healthcare operations supervisor (coding compliance & appeals)
Builds
Code editing adjudication workflows and compliance standards for managed care organizations
Domain
Healthcare / Medical Billing & Coding
Required skills
code editing software systems, CPT coding, claims analysis, data management, account management, nursing, healthcare management, coding analytics, quality audit compliance, state fair hearing testimony, vendor liaison
Preferred skills
Certified Professional Coder (CPC), RN license, managed care organization experience
Responsibilities
Ensure Coding Analytics team meets production standards and passes quality audits; oversee relationships with health plans and claims departments; identify and implement operational efficiencies; serve as health plan account liaison for code editing decisions; research coding questions and issues; provide expert testimony in state fair hearings; triage and resolve escalated inquiries from health plans, claims, and providers; communicate across IT, health plans, vendors, and departments.
Seniority
Senior, hands-on IC