REMOTE Summary of Position
- Provide enterprise-wide strategic leadership for the Coding Integrity and Provider Reimbursement teams within the Payment Integrity organization.
- Oversee departmental operations, policies, and procedures to ensure alignment with health plan standards and compliance with federal and state regulatory requirements.
- Serve as the organization's lead coding resource, advising cross-functional leaders and driving performance across internal and external programs.
Principal Accountabilities
- Lead coding strategy and execution to achieve gross and incremental savings targets.
- Lead the development and enterprise-wide management of clinical coding guidelines, including the creation, maintenance, and alignment of policies with industry standards and regulatory requirements. Ensure a structured and compliant approach to coding integrity across all lines of business.
- Drive enterprise-wide operational efficiency and cost-effectiveness by leading the full lifecycle of strategic policy and coding initiatives-from development and approval through implementation and communication. Evaluate and forecast the financial impact of coding and policy changes to deliver measurable medical cost savings.
- Serve as the primary coding advisor across the enterprise, ensuring consistency and compliance.
- Lead implementation and expansion of coding-related programs, including cost-benefit analysis.
- Identify and implement improvements in systems, procedures, and workflows.
- Monitor provider abrasion and drive reductions in appeal rates and recovery adjustments.
- Deliver standardized operational processes across vendors and internal teams.
- Provide mentorship and guidance to team members, fostering a culture of collaboration, innovation, and continuous learning.
- Ideate and identify new opportunities for program growth and optimization.
- Ensure adherence to applicable federal, state, and local regulations.
- Perform other related tasks/projects as directed, requested, or required.
Qualifications Education, Training, Licenses, Certifications
- Bachelor's Degree required.
- Certified Coder (ex., CPC, CIC, CIMC)
Relevant Work Experience, Knowledge, Skills, and Abilities
- 10 - 12+ years of relevant, professional work experience. (Required)
- 5+ years of staff/process management experience in health care or reimbursement/coding methods, preferably within a managed care environment. (Required)
- 5+ years' experience in ICD-10 & CPT-4 coding w/certification in AAPC or AHIMA for direct oversight of coding functions. (Required)
- Demonstrated in-depth knowledge of state and federal regulations and CMS reimbursement methods. (Required)
- Demonstrated experience in the development and delivery of employee training/development. (Required)
- Excellent communication skills (verbal, written, presentation, interpersonal) with all types/levels of audiences. (Required)
- Proficient with MS Office (Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc.). (Required)
- Outstanding attention to detail and organizational, quantitative, and analytical abilities. (Required)
Additional Information
- Requisition ID: 1000003399
- Hiring Range: $113,400-$210,600
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EmblemHealth
Oct 22, 2026