Manager, Claims Analytics & Reimbursement Policy

Medica; St. Louis (MO); On-site; USD 79,000 - 135,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

Paid time off

Holidays

Job summary

Medica is a nonprofit health plan delivering care across multiple states and communities. The Manager, Coding leads Payment Analytics and Reimbursement Policy, guiding analysts, auditing processes, and reporting results to senior leadership.

The role focuses on reverse engineering vendor savings, identifying cost leakage, and driving improvements in pre-payment solutions, recovery activities, and claim payment accuracy.

Qualifications

• Bachelor's degree or equivalent experience in related field.
• 7+ years of progressive experience in claims and coding beyond degree.
• 5+ years of people leadership in healthcare operations.

Responsibilities

• Forecast potential and error savings from analyzing claims data.
• Oversee monthly saving efforts by analysts.
• Recover overpayments identified through retrospective data analytics.
• Identify root causes of errors; drive process improvements and adjust claims editing solutions.
• Maintain relationships with Medica’s claim processing vendor for policy management and accuracy.
• Stay updated on corporate policies, regulatory codes and guidelines.
• Set priorities for staff following up on payment integrity leads.

Skills

Claims & coding experience

People leadership

Healthcare operations

Education

Bachelor's degree or equivalent

Related field experience

Job description

Medica is a nonprofit health plan delivering care across multiple states and communities. The Manager, Coding leads Payment Analytics and Reimbursement Policy, guiding analysts, auditing processes, and reporting results to senior leadership.

The role focuses on reverse engineering vendor savings, identifying cost leakage, and driving improvements in pre-payment solutions, recovery activities, and claim payment accuracy.