Opportunity Overview: We are seeking a dynamic Payment Selections Manager to join our Payment Integrity team. In this role, you will drive the identification and recovery of improper claim payments, serving as a critical "player-coach" who balances high-level strategy with hands-on technical execution. You’ll partner closely with Data Science, IT, and Compliance teams to build innovative auditing algorithms, providing an opportunity to directly impact our payer clients' financial accuracy and operational excellence.

What You’Ll 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. Serve as a subject matter expert on inpatient coding, DRGs, ICD-10-CM/PCS, MS-DRGs, APR-DRGs, and hospital reimbursement methodologies.

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.

Continuously identify opportunities to improve internal processes and workflows within the concept development lifecycle. Ensure compliance by maintaining deep expertise in ICD-10, CPT, HCPCS, and payer reimbursement methodologies. What you’ll need: Must-haves 8+ years of experience in inpatient claims auditing, DRG validation, payment integrity, coding, or healthcare revenue cycle operations.

Demonstrated expertise within a healthcare or payer environment. , CPC, CIC,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-haves 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.

Perks

: 💻 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 The salary range for this position is $110,000 to $122,000 annually; as part of a total

Benefits

package which includes health insurance, 401k and bonus.

Compensation

range for this role.

Qualifications

for the role, experience level, skillset, and internal alignment. Interview Process*: Connect with Talent Acquisition for a Preliminary Phone Screening Meet your Hiring Manager! Behavioral Interview(s) *Subject to change About Cohere Health: Cohere Health’s clinical intelligence platform delivers AI-powered solutions that streamline access to quality care by improving payer-provider collaboration, cost containment, and healthcare economics.

Cohere Health works with over 660,000 providers and handles over 12 million prior authorization requests annually. Its responsible AI auto-approves up to 90% of requests for millions of health plan members.

Payment Selections Manager (Inpatient/DRG)