Provider Reimbursement Manager

The Provider Reimbursement Manager oversees provider reimbursement strategies for assigned Medicaid markets, acting as the primary contact for market leaders to align on prepay editing initiatives. This role involves translating evolving state regulatory guidelines into actionable edit requirements, driving cost-of-care performance improvements, and maintaining a centralized repository of compliance rules. As a subject matter expert, the manager collaborates cross-functionally with clinical, coding, and analytics teams to ensure effective operationalization of reimbursement policies and coding accuracy.