Senior Manager - Payment Integrity

Department: Payment Integrity

We are seeking a Senior Manager with strong US Healthcare domain knowledge and proven training experience. This role involves consulting on healthcare processes, driving compliance, and delivering impactful training programs to internal teams and clients with focus on Provider contracts & pricing

Job Summary:

The Senior Manager will serve as a Domain expert in contract loading, concept validation & flagging discrepancies to ensure payment accuracy and integrity, while also leading training initiatives for internal teams and clients. This role involves providing strategic consulting, designing and delivering training programs, and ensuring operational excellence across teams. The manager will collaborate with stakeholders to implement best practices, optimize workflows, and drive transformation initiatives. This role demands strong analytical skills, attention to detail, and a deep understanding of claims processing and contract management systems.

Key Area of Responsibilities:

A. Contract loading & Consulting

• Provide expertise in US healthcare regulations, payer-provider processes, HIPAA compliance, and revenue cycle management.
• Review and update contract details including fee schedules, reimbursement rates, and payment terms to support accurate claims adjudication.
• Ensure timely and precise updates to contract data, reflecting the most current agreement terms and minimizing payment discrepancies.
• Support implementation of technology-driven solutions for operational efficiency.

B. Training & Development

• Design and deliver training programs for internal teams and client staff on US healthcare processes, compliance, and operational best practices.
• Develop training materials, SOPs, and e-learning modules related to Contract loading & claims flagging
• Conduct workshops, webinars, and knowledge-sharing sessions.

C. Process Improvement & Advisory

• Identify gaps in current workflows and propose solutions to enhance accuracy and compliance.
• Collaborate with cross-functional teams to implement process improvements.
• Prepare and present reports, dashboards, and recommendations to senior stakeholders.

D. Compliance & Quality Assurance

• Ensure adherence to healthcare regulations and company policies in all consulting and training activities.
• Stay updated on industry regulations and emerging trends in US healthcare.

Education & Experience:

• Graduation or equivalent (required).
• 7+ years of experience in healthcare and claims adjudication.
• 2+ years of experience in training will be preferred.
• 3+ years of experience in Prepay/Post-pay Payment Integrity, Data Mining or Contract Audit
• Knowledge of healthcare reimbursement systems, payer-provider contracts, and claims adjudication processes is a plus.

Skills & Competencies:

• Strong understanding of contract rate loading and healthcare payment processing systems, with the ability to interpret and apply complex provider agreements.
• Highly detail-oriented with strong analytical and problem-solving capabilities, especially in identifying payment discrepancies and root causes.
• Proficient in Microsoft Office Suite, particularly Excel (e.g., pivot tables, formulas, VLOOKUP), along with Word and Outlook for documentation and communication.
• Hands-on experience with healthcare claims platforms such as Facets, TriZetto, or similar systems used in US healthcare operations.
• Excellent verbal and written communication skills, enabling effective collaboration with internal teams and external stakeholders.
• Strong organizational and time management skills, with the ability to handle multiple priorities and meet tight deadlines in a dynamic environment.