- Remote, United States
- Remote
- Full-time · Manager
- $111K–$150K per year
- 6–8 years
Senior Manager overseeing provider escalation and education, resolving complex claims disputes and leading root cause investigations.
Compensation
Salary range: $110,500 - $150,000 /year
Responsibilities
- Serve as ultimate escalation authority for complex claims disputes, OON pricing appeals, and coding challenges
- Own end-to-end resolution of high-priority CTM cases, appeals, and provider disputes
- Lead research into CMS guidelines, MAC policies, LCDs/NCDs, and federal regulations
- Partner with technical teams to build automation, custom logic rules, and AI-enabled workflows
- Ensure CTM investigations meet regulatory compliance and SLA benchmarks
Requirements
- Nice to have: Certified Professional Coder (CPC) credential
- Nice to have: automation or AI-enabled workflows in claims or appeals environment