Payment Integrity Manager - Claims Analytics

Medica; Madison (WI); On-site; USD 79,000 - 118,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

PTO

Holidays

Paid volunteer time off

401K contributions

Job summary

Medica is seeking a Manager, Coding to lead Payment Analytics and Reimbursement Policy, guiding data-driven decisions and audits. The role oversees vendor relationships, policy management, and continuous improvement in claims payment accuracy.

A strong leader will drive results and manage audits, trending, and staff development. The position requires onsite work three days a week, with locations in Minnetonka, Madison, St.

Qualifications

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

Responsibilities

• Develop a forecast of potential and error savings goals for analyzing claims data.
• Oversee the day‑to‑day processes used by analysts to perform monthly savings efforts.
• Recover overpayments identified through retrospective data analytics.
• Uncover root cause of errors, influence stakeholders, sponsor process improvement, and continuously enhance claims editing solutions.
• Develop and maintain good working relationship with Medica’s claim processing vendor to drive ongoing claim policy management to enhance claim processing accuracy and adjustment reduction.
• Maintain up‑to‑date knowledge of corporate policies, regulatory codes, legislative directive, and other guidelines.
• Set priorities for staff dedicated to following up on payment integrity leads from vendors.

Skills

Bachelor's degree

7+ years claims experience

5+ years leadership

Education

Bachelor's degree or equivalent experience in related field

Job description

Medica is seeking a Manager, Coding to lead Payment Analytics and Reimbursement Policy, guiding data-driven decisions and audits. The role oversees vendor relationships, policy management, and continuous improvement in claims payment accuracy.

A strong leader will drive results and manage audits, trending, and staff development. The position requires onsite work three days a week, with locations in Minnetonka, Madison, St.