Payment Integrity Concept Development SME

The Subject Matter Expert (SME) – Payment Integrity Concept Development is responsible for designing, developing, and validating innovative payment integrity concepts that identify inaccurate, inappropriate, or unsupported healthcare claims. This individual combines deep expertise in medical coding, reimbursement methodologies, clinical documentation, regulatory guidance, and claims analytics to develop high-value overpayment detection opportunities that generate measurable savings.

The ideal candidate has a proven history of successfully developing new payment integrity concepts from initial idea through implementation, resulting in significant financial recoveries while maintaining high clinical accuracy and low provider abrasion.

*Base Pay Range: $75,100 - $107,300/yr

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Originally posted on Himalayas