Opportunity Overview:
We are seeking a versatile and highly skilled Payment Training Manager to join our dynamic Payment Integrity team. This critical role translates Quality Control (QC) feedback and concept development insights into actionable high-impact training programs for our medical audit team to drive accuracy and reduce variance.
Ideal candidates should possess a CCS credential, expert knowledge of CPT, HCPCS, and ICD-10-CM/PCS coding guidelines, and a passion for detailed analytical auditing, play a key role in delivering accurate reimbursement solutions and maintaining audit excellence. The ideal candidate is self-motivated, thrives in a remote and fast-paced environment, and is committed to precision, compliance, productivity, and continuous learning within a high-growth organization.
What You'll Do:
- Translate complex clinical and coding audit concepts into structured training modules.
- Partner with QC Analyst to isolate systemic auditor knowledge gaps.
- Convert QC error trends into targeted, remedial education updates.
- Work with Concept Developers to build training for new audit ideas.
- Conduct live virtual training sessions and workshops for auditing staff.
- Measure training impact by tracking post-education QC accuracy scores.
- Build interactive training materials for both onboarding and continuous learning.
- Provide clear, constructive, and actionable feedback to auditors to improve quality, productivity, and decision-making accuracy.
- Drive adoption and effective utilization of Cohere Validate, the internal audit support tool, while providing actionable feedback and enhancement recommendations to improve functionality and audit efficiency.
- Demonstrate flexibility in using integrated audit technologies, including Encoder, Grouper, and Pricer tools within the internal auditing platform.
- Stay ahead of industry trends, coding changes, and payment policy updates to maintain expert-level knowledge.
- Adhere to HIPAA and company policies to ensure data privacy, security, and regulatory compliance.
What You'll Need:
- 8+ years of overall experience in medical coding, claims auditing, payment integrity, or healthcare reimbursement.
- Expert knowledge of CPT, HCPCS, ICD-10-CM, modifiers, medical necessity, and reimbursement methodologies.
- Deep understanding of outpatient claims coding and auditing for Commercial, Marketplace, Medicare, and Medicaid lines of business.
- Hands-on experience reviewing programs such as HCD, DME, SNF, HH, E&M, Surgery, ASC, Observation, ER, and Infusion claims.
- Excellent written and verbal English communication skills with ability to deliver clear feedback and training.
- Proficiency instructional design tools i.e., PowerPoint, Google Slides.
- Self-motivated and able to work independently in a remote environment while maintaining high perfo