Remote Senior Manager, Payment Integrity & Clinical Edits
Ladders
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Benefits offered by this job
Job summary
Ladders is seeking a Payment Integrity Program Development Senior Manager – Clinical & Facility Specialist to join our client’s team in the Hospitals & Medical Centers space. This role focuses on developing innovative payment integrity concepts, improving claim review accuracy, and supporting sound reimbursement practices.
The successful candidate will partner with clinical, coding, analytics, and operations teams to translate complex medical policy ideas into scalable edit logic, drawing on
Qualifications
- Active RN license with inpatient clinical experience and coding certification (CPC/CCS/CCS-P/RHIA).
- 5+ years as primary author of new payment edits within health plans or vendors.
- Strong knowledge of Medicare rules, LCDs/NCDs, and inpatient/outpatient billing dynamics.
Responsibilities
- Drive concept development by researching literature and identifying payment anomalies.
- Create automated payment integrity logic from clinical documentation and coding frameworks.
- Analyze data to validate clinical hypotheses and assess financial viability.
- Lead cross-functional discussions to align policy interpretations and edit logic.
- Manage multi-phase concept rollouts from discovery through performance tracking.
Skills
Job description
Ladders is seeking a Payment Integrity Program Development Senior Manager – Clinical & Facility Specialist to join our client’s team in the Hospitals & Medical Centers space. This role focuses on developing innovative payment integrity concepts, improving claim review accuracy, and supporting sound reimbursement practices.
The successful candidate will partner with clinical, coding, analytics, and operations teams to translate complex medical policy ideas into scalable edit logic, drawing on
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