Payment Integrity Coding Manager

🕒 May 18

🌲 Oregon – Remote

🌲 Oregon – Remote

💵 $92.1k - $112.5k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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CareOregon

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1994

⚕️ Healthcare Insurance

🤝 Non-profit

Healthcare Insurance • Non-profit

CareOregon is a community-focused health plan that provides coordinated physical, behavioral, dental and social-support services to Oregon Health Plan members, serving more than 500,000 people. The organization operates provider and member portals, offers care coordination, telehealth, language and tribal services, community grants and outreach, and programs addressing social determinants of health such as housing, nutrition and transportation.

📋 Description

• Oversee monitoring, analysis, and reporting of claims activity (e.g., trends, outliers, high-cost claims, line-of-business segmentation) • Manage development and maintenance of tracking mechanisms, dashboards, and documentation related to audits, findings, and overpayment recoveries • Ensure accurate invoicing and reconciliation for programs and vendors; oversee processing of recoupments and refunds • Identify root causes of overpayments, track trends, and drive corrective actions with accountable owners • Define and execute the enterprise payment integrity and coding audit strategy; align program goals with CareOregon’s mission, vision, values, and strategic plan

🎯 Requirements

• Minimum 5 years’ management experience in health plan claims operations, audit, and/or payment integrity • Minimum 5 years’ experience as a certified coder and/or Certified Coding auditor with active certification AHIMA or AAPC (e.g., CPC, CCS, CCA, CMC or equivalent) • Preferred experience performing statistical claims analysis in a managed care or health care setting. • Experience in and/or understanding of payment integrity programs and vendors. • Experience with SQL Server Reporting, or using business intelligence tools (e.g., Tableau) and data framework.

🏖️ Benefits

• Health insurance • 401(k) matching • Paid time off • Flexible spending account(s) • Lifestyle spending account • Employee assistance program • Wellness program • Discounts • Supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings)