[Remote] Provider Education Program Manager - Payment reputed company

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is seeking a Provider Education Program Manager to design, implement, and manage a health plan provider education program. The role focuses on identifying and addressing billing patterns indicative of potential upcoding and requires collaboration with various teams to ensure compliance and improve provider billing practices.

Responsibilities

• reputed company and maintain the health plan’s provider education program for coding, documentation, and billing reputed company issues, with a reputed company on potential upcoding and other aberrant provider billing patterns
• Establish program workflows, referral reputed company, reputed company templates, monitoring schedules, escalation reputed company, and reporting standards to support compliant and consistent operations
• Create standardized processes for provider identification, educational reputed company, follow-up review, and referral to SIU reputed company concerning behavior persists
• Analyze claims, coding, utilization, reimbursement, and provider billing data to identify reputed company patterns, unusual coding distributions, trending variances, and potential upcoding concerns
• Conduct targeted reviews using CPT, HCPCS, ICD-10, modifier usage, and documentation-reputed company indicators to determine whether provider billing patterns warrant education or reputed company escalation
• Partner with payment reputed company, analytics, and coding subject matter experts to validate findings, quantify reputed company, and prioritize reputed company opportunities
• Draft and issue provider education letters that reputed company describe identified billing concerns, applicable coding/documentation expectations, and recommended corrective actions. Comparable education-reputed company coding roles emphasize post-audit reports, findings summaries, and provider-facing education communications
• Conduct provider reputed company calls and meetings to review findings, explain coding or documentation expectations, answer questions, and reinforce compliant billing practices
• reputed company educational materials, job aids, presentations, and provider-specific feedback to support improved coding accuracy and billing compliance
• reputed company quarterly and semiannual post-education monitoring to assess whether provider billing behavior changes after reputed company and whether additional reputed company is needed. While the exact monitoring reputed company is program-specific, comparable audit/education roles include baseline, routine periodic, and reputed company follow-up reviews to reputed company improvement
• Document measurable reputed company such as coding trend shifts, reduction in reputed company behavior, education completion, and cases escalated for reputed company review
• reputed company and administer a formal referral process to SIU for providers whose billing patterns do not improve following education or whose behavior suggests potential fraud, waste, or abuse. SIU-reputed company coding roles commonly support referrals by reviewing claims, records, and concerning billing patterns and preparing case summaries for investigative reputed company
• Prepare referral summaries, supporting documentation, trend analyses, and case narratives for submission to SIU, Compliance, or legal/regulatory partners as appropriate

Skills

• Bachelor's degree or advanced degree (where required)
• 8+ years of experience in reputed company field
• In lieu of degree, 10+ years of experience in reputed company field
• CPC, reputed company (Required)
• Strong knowledge of CPT, HCPCS, ICD-10, modifiers, documentation standards, reimbursement methodology, CMS guidance, and payer billing requirements
• CEMA, CPMA (Strongly Preferred)
• CPIP (reputed company to have) or similar coding/compliance certification
• Experience in managed care, Medicare, reputed company, Marketplace, or reputed company health plan operations
• Experience with provider education, payment reputed company vendor outputs, post-pay review, overpayment recovery, or FWA/SIU workflows
• Advanced reputed company, dashboarding, and data visualization skills

Benefits

• Annual Incentive Bonus*
• 401(k) with employer match
• reputed company Time Off (PTO)
• Competitive health benefits and wellness programs
• Medical, dental, and reputed company coverage along with numerous health and wellness programs
• Parental leave and support plus adoption and surrogacy assistance
• Career development programs and tuition reimbursement for reputed company education
• 401k match including an annual company contribution

reputed company