Payment Integrity Content Portfolio Manager, Drugs and Biologicals - Remote

Overview

The Payment Integrity Content Portfolio Manager will oversee the FDA Drugs and Biologicals portfolio, contributing to healthcare technology improvements through data-driven insights and effective management of content creation.

In Short

• Manage the FDA Drugs and Biologicals portfolio, including scoping, design, and quality control.
• Work with on and offshore resources to develop professional edits for drugs and biologicals.
• Educate and mentor content analysts to ensure quality output.
• Develop timelines for initiatives and manage teams to meet deliverables.
• Provide subject matter expertise to address pharmacy-related client needs.
• Review and maintain edits based on Medicare, Medicaid, and FDA guidelines.
• Create and manage special projects from concept through execution.
• Collaborate with engineering teams to troubleshoot and resolve editing issues.
• Drive policy adoption and savings rates for drugs and biologicals edits.
• Validate edits with claims data and ensure they function as intended.

Requirements

• 4-6 years of experience in payment integrity within a health plan or claims editing vendor.
• Medical coding certification or equivalent degree.
• Experience with FDA drug labels and making medical coding edits.
• Expertise in National Drug code data and claims edits.
• Strong communication skills and experience with client interactions.
• Advanced skills in Google Suite.
• Experience managing claims editing implementations.
• Ability to interpret medical policies and apply coding guidelines.
• Deep knowledge of claims edits’ error reasons and analytics.
• Experience presenting to clients and negotiating requests.

Benefits

• Flexible work environment with a home office stipend.
• Equity and 401k matching.
• Unlimited PTO and wellness reimbursements.
• Comprehensive health plans with premium contributions.
• Mental and physical wellness support through various subscriptions.