Payment Integrity Concept Development SME

ExlService Holdings, Inc.; United States; Sur place; USD 75 000 - 107 000; Plein temps

Résumé du poste

ExlService Holdings, Inc. in the United States seeks a Subject Matter Expert (SME) for Payment Integrity Concept Development who designs, develops, and validates innovative concepts to identify inaccurate or unsupported healthcare claims.

The ideal candidate combines medical coding, reimbursement methodologies, clinical documentation, regulatory guidance, and claims analytics to generate high-value overpayment detection opportunities with measurable savings.

Responsabilités

• Design, develop and validate innovative payment integrity concepts.
• Identify overpayments and generate measurable savings.
• Ensure high clinical accuracy with low provider abrasion.

Description du poste

The Subject Matter Expert (SME) – Payment Integrity Concept Development is responsible for designing, developing, and validating innovative payment integrity concepts that identify inaccurate, inappropriate, or unsupported healthcare claims. This individual combines deep expertise in medical coding, reimbursement methodologies, clinical documentation, regulatory guidance, and claims analytics to develop high-value overpayment detection opportunities that generate measurable savings.

The ideal candidate has a proven history of successfully developing new payment integrity concepts from initial idea through implementation, resulting in significant financial recoveries while maintaining high clinical accuracy and low provider abrasion.

*Base Pay Range: $75,100 - $107,300/yr

For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits