Remote Jobs at First Choice Health

POSITION SUMMARY: We are seeking a detail-oriented and experienced Payment Policy & Audit Manager to oversee and manage the development, implementation, and maintenance of payment policies by analyzing regulatory changes and reimbursement models to ensure compliance with federal, state, and payer-specific guidelines. This role ensures compliance with regulatory requirements, optimizes reimbursement processes, and collaborates with internal stakeholders to streamline payment procedures.The Payment Policy & Audit Manager is a highly cross-functional role and will work closely with our network, claims operations, claims configuration, and medical management. KEY RESPONSIBILITIES: Leadership • Manage the appeals and quality audit team. (3 people) • Oversee the appeals process ensuring compliance with regulations and internal policies. • Investigate and resolve complex appeals, providing clear and concise resolutions. • Track and report on appeals data, identifying trends and areas for i ...