Opportunity Overview:

We are seeking a dynamic Payment Selections Manager to join our Payment Integrity team. In this role, you will drive the identification and recovery of improper claim payments, serving as a critical "player-coach" who balances high-level strategy with hands-on technical execution. You’ll partner closely with Data Science, IT, and Compliance teams to build innovative auditing algorithms, providing an opportunity to directly impact our payer clients' financial accuracy and operational excellence.

What you’ll do:

• Research and document new payment integrity concepts by analyzing medical policies, billing regulations, and reimbursement logic.
• Translate complex billing rules into precise technical specifications for automated claim auditing algorithms.
• Serve as a subject matter expert on inpatient coding, DRGs, ICD-10-CM/PCS, MS-DRGs, APR-DRGs, and hospital reimbursement methodologies.
• Perform expert-level claims auditing to validate potential improper payment scenarios and ensure accuracy before deployment.
• Conduct hands-on data analysis using Microsoft Excel to explore datasets and quantify savings potential for clients.
• Collaborate cross-functionally as the primary liaison between the team, IT, and the Director of Payment Solutions to align on project scopes and timelines.
• Continuously identify opportunities to improve internal processes and workflows within the concept development lifecycle.
• Ensure compliance by maintaining deep expertise in ICD-10, CPT, HCPCS, and payer reimbursement methodologies.

What you’ll need:

Must-haves

• 8+ years of experience in inpatient claims auditing, DRG validation, payment integrity, coding, or healthcare revenue cycle operations.
• Demonstrated expertise within a healthcare or payer environment.
• An active certified coder credential (e.g., CPC, CIC,CCS, RHIA, or RHIT).
• Proficiency with Microsoft Excel (advanced level) and a strong understanding of healthcare revenue cycles.
• Ability to balance individual technical contributions with managerial duties in a fast-paced environment.
• Bachelor’s or Associate’s degree in Health Information Management, Health Informatics, or a related field.

Nice-to-haves

• Dual Credentialing: Preference for candidates holding both a coding credential (CCS/CPC) and an HIM credential (RHIA/RHIT).
• Advanced Experience in developing or specifying claim auditing algorithms and edits.
• Familiarity with advanced data science platforms or IT implementation strategies.

Pay & Perks:

💻 Fully remote opportunity with about 5% travel

🩺 Medical, dental, vision, life, disability insurance, and Employee Assistance Program

📈 401K retirement plan with company match; flexible spending and health savings account

🏝️ Flex Time Off + company holidays

👶 Up to 14 weeks of paid parental leave

🐶 Pet insurance

The salary range for this position is $110,000 to $122,000 annually; as part of a total benefits package which includes health insurance, 401k and bonus. In accordance with state applicable laws, Cohere is required to provide a reasonable estimate of the compensation range for this role. Individual pay decisions are ultimately based on a number of factors, including but not limited to qualifications for the role, experience level, skillset, and internal alignment.

Interview Process*:

1. Connect with Talent Acquisition for a Preliminary Phone Screening
2. Meet your Hiring Manager!
3. Behavioral Interview(s)

*Subject to change

About Cohere Health:

Cohere Health’s clinical intelligence platform delivers AI-powered solutions that streamline access to quality care by improving payer-provider collaboration, cost containment, and healthcare economics. Cohere Health works with over 660,000 providers and handles over 12 million prior authorization requests annually. Its responsible AI auto-approves up to 90% of requests for millions of health plan members.

With the acquisition of ZignaAI, we’ve further enhanced our platform by launching our Payment Integrity Suite, anchored by Cohere Validate™, an AI-driven clinical and coding validation solution that operates in near real-time. By unifying pre-service authorization data with post-service claims validation, we’re creating a transparent healthcare ecosystem that reduces waste, improves payer-provider collaboration and patient outcomes, and ensures providers are paid promptly and accurately.

At Cohere Health, Payment Integrity isn’t just about catching errors—it’s about transforming how healthcare dollars are spent to ensure accuracy, fairness, and better outcomes for everyone. By combining advanced analytics, clinical expertise, and cutting-edge technology, the team works at the intersection of healthcare and innovation to proactively identify opportunities, reduce waste, and strengthen trust between payers and providers. Joining this mission means being part of a forward-thinking organization that values curiosity, collaboration, and impact—where your work directly contributes to a more efficient healthcare system and helps ensure patients receive the right care at the right time and providers receive the right payment.

Cohere Health’s innovations continue to receive industry wide recognition. We’ve been named to the 2025 Inc. 5000 list and in the Gartner® Hype Cycle™ for U.S. Healthcare Payers (2022-2025), and ranked as a Top 5 LinkedIn™ Startup for 2023 & 2024. Backed by leading investors such as Deerfield Management, Define Ventures, Flare Capital Partners, Longitude Capital, and Polaris Partners, Cohere Health drives more transparent, streamlined healthcare processes, helping patients receive faster, more appropriate care and higher-quality outcomes.

The Coherenauts, as we call ourselves, who succeed here are empathetic teammates who are candid, kind, caring, and embody our core values and principles. We believe that diverse, inclusive teams make the most impactful work. Cohere is deeply invested in ensuring that we have a supportive, growth-oriented environment that works for everyone.

We can’t wait to learn more about you and meet you at Cohere Health!

Equal Opportunity Statement:

Cohere Health is an Equal Opportunity Employer. We are committed to fostering an environment of mutual respect where equal employment opportunities are available to all. To us, it’s personal.

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