Strategic Director, Coding Integrity & Reimbursement

EmblemHealth; New York (NY); Remote; USD 113,000 - 211,000; Full time

Job summary

EmblemHealth is seeking a senior leader to oversee Coding Integrity and Provider Reimbursement within the Payment Integrity organization. The role drives enterprise-wide coding strategy, policy creation, and cross-functional collaboration to meet regulatory standards and optimize costs.

Responsibilities include leading initiatives, developing guidelines, forecasting financial impact, and mentoring teams to deliver standardized processes across vendors and internal groups.

Qualifications

• Proven leadership and strategic management experience.
• Strong communication and presentation skills.
• In-depth knowledge of coding, reimbursement, and regulatory methods.
• Ability to develop training and onboarding for teams.

Responsibilities

• Provide enterprise-wide strategic leadership for Coding Integrity and Provider Reimbursement teams.
• Oversee operations, policies, and procedures to align with plan standards and regulatory requirements.
• Lead coding strategy to achieve savings targets and ensure compliance across programs.
• Drive implementation of coding-related programs and measure financial impact of policy changes.
• Mentor team members and foster collaboration and continuous learning.
• Ensure adherence to federal, state, and local regulations.

Skills

Leadership

Communication

Regulatory knowledge

Healthcare reimbursement

Education

Bachelor's Degree

Certified Coder (CPC, CIC, CIMC)

Tools

MS Office

Job description

EmblemHealth is seeking a senior leader to oversee Coding Integrity and Provider Reimbursement within the Payment Integrity organization. The role drives enterprise-wide coding strategy, policy creation, and cross-functional collaboration to meet regulatory standards and optimize costs.

Responsibilities include leading initiatives, developing guidelines, forecasting financial impact, and mentoring teams to deliver standardized processes across vendors and internal groups.