Payment Selections Manager (Healthcare)

TL;DR

Payment Selections Manager (Healthcare): Driving the identification and recovery of improper claim payments with an accent on building innovative auditing algorithms. Focus on translating complex billing rules into technical specifications and conducting hands-on data analysis to quantify savings potential for clients.

Location: United States

Salary: $110,000 to $122,000 annually

Company

hirify.global’s clinical intelligence platform delivers AI-powered solutions that streamline access to quality care by improving payer-provider collaboration, cost containment, and healthcare economics.

What you will do

• Research and document new payment integrity concepts by analyzing medical policies, billing regulations, and reimbursement logic.
• Translate complex billing rules into precise technical specifications for automated claim auditing algorithms.
• Perform expert-level claims auditing to validate potential improper payment scenarios and ensure accuracy before deployment.
• Conduct hands-on data analysis using Microsoft Excel to explore datasets and quantify savings potential for clients.
• Collaborate cross-functionally as the primary liaison between the team, IT, and the Director of Payment Solutions to align on project scopes and timelines.
• Ensure compliance by maintaining deep expertise in ICD-10, CPT, HCPCS, and payer reimbursement methodologies.

Requirements

• Must be based in the United States
• 8+ years of experience in claims auditing, data analysis, or payment integrity concept design.
• Demonstrated expertise within a healthcare or payer environment.
• An active certified coder credential (e.g., CPC, CCS, RHIA, or RHIT).
• Proficiency with Microsoft Excel (advanced level) and a strong understanding of healthcare revenue cycles.
• Ability to balance individual technical contributions with managerial duties in a fast-paced environment.
• Bachelor’s or Associate’s degree in Health Information Management, Health Informatics, or a related field.

Nice to have

• Dual Credentialing: Preference for candidates holding both a coding credential (CCS/CPC) and an HIM credential (RHIA/RHIT).
• Advanced Experience in developing or specifying claim auditing algorithms and edits.
• Familiarity with advanced data science platforms or IT implementation strategies.

Culture & Benefits

• Fully remote opportunity with about 5% travel
• Medical, dental, vision, life, disability insurance, and Employee Assistance Program
• 401K retirement plan with company match; flexible spending and health savings account
• Flex Time Off + company holidays
• Up to 14 weeks of paid parental leave
• Pet insurance

Hiring process

• Connect with Talent Acquisition for a Preliminary Phone Screening
• Meet your Hiring Manager!
• Behavioral Interview(s)