Job Description

Of the $3.8T we spend on healthcare in the United States annually, about a third of it is estimated to be lost due to waste, fraud and abuse.  Codoxo is the premier provider of artificial intelligence-driven solutions and services that help healthcare companies and agencies proactively detect and reduce risks from fraud, waste, and abuse and ensure payment integrity. Codoxo helps clients manage costs across network management, clinical care, provider coding and billing, payment integrity, and special investigation units. Our software-as-a service applications are built on our proven Forensic AI Engine, which uses patented AI-based technology to identify problems and suspicious behavior far faster and earlier than traditional techniques.

We are venture backed by some of the top investors in the country, with strong financials, and remain one of the fastest growing healthcare AI companies in the industry. 

Summary:

Provider Scope helps healthcare payers and agencies bring down costs pre-claim with unique provider insights. As the Manager of Provider Education Operations, you are responsible for overseeing the development, implementation, operations and management of Provider Scope. The Manager will lead a team of education specialists and coordinators, ensuring the effective delivery of educational initiatives and continuous improvement of educational programs.

Key Responsibilities:

• Lead and oversee the operations related to Provider Scope
• Collaborate with product, engineering and data science teams, providing expert guidance on operational processes
• Lead the ideation for provider identification, themes and concepts
• Supervise the evaluation of post-pay or pre-pay claims, ensuring compliance with standard principles, state, federal and customer-specific policies and regulations to detect incorrect coding, abuse, fraudulent billing practices, waste, overpayments, and processing errors.
• Support and guide internal teams in the build, development, and implementation of Provider Scope operations
• Speak with providers in a professional manner; Lead and mentor teams responsible for speaking with providers
• Serve as a primary point of contact for Provider Scope customers regarding findings from company software, providing expert assistance and guidance to customers navigating company software.
• Maintain customer meeting schedules, agendas, notes and follow up items
• Maintain and execute on internal customer timelines for Provider Scope
• Lead, mentor, and train team members, fostering a cooperative and constructive team environment.
• Oversee additional duties and projects as assigned by senior management:
• Impart knowledge for additional product and company initiatives
• Ensure the security and confidentiality of all protected health information encountered in the performance of duties.

Qualifications:

• Active CCA, CCS, CPC or equivalent coding certification with extensive facility and professional claims audit and FWA experience.
• Experience with education of providers on coding behavior, within a health plan or with a vendor
• Minimum of 5 years of experience in cost containment, payment integrity, fraud, audit, compliance, or analytics roles.
• Operational experience, project management experience, managing a team or process
• At least 5 years of experience within health plans, facilities, government,  vendor, or other similar industry roles.
• Experience with JIRA/Confluence preferred
• In-depth knowledge of claims processing, billing and coding, facility and professional contracting, and reimbursement methodologies.
• Proven expertise in data analytics.
• Experience with speaking with providers regarding coding behavior
• Comprehensive understanding of medical terminology, medical records, health information management, and medical coding, including DRG methodologies, CPT/HCPCS coding guidelines, Physician Specialty guidelines, reimbursement programs, claims adjudication processes, member contract benefits, and regulatory agency policies (CMS/HCFA, DOI, State regulations), and provider billing systems and practices.
• Thorough knowledge of insurance operations and the organizational impact of decision-making.
• Bachelor's degree or higher preferred.
• Advanced proficiency in Excel, including creating and updating spreadsheets, pivot tables, and formulas.

Benefits for You

Health, Dental, and Vision insurance with 100% employee premium coverage (Starts Day 1)

Unlimited PTO

Annual Professional Development stipend

Annual home office stipend

401K Match (after 90 days)

We are an Equal Opportunity Employer:

Codoxo provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.  This policy applies to all terms and conditions of employment.