The Payment Integrity Edits Manager is a member of the CGI Payment Integrity Department, with responsibility over the edits life cycle, including development and maintenance of an edits management process. This role will be client-facing, supporting business development and client delivery as a subject matter expert regarding edits development and management.
The Payment Integrity Edits Manager has a sound knowledge base in edit research and development in pre- and post-payment medical claims auditing in conjunction with maintaining a robust quality assurance program. Edits are developed through a well-defined process which requires the Edits Manager to incorporate clinical experience, knowledge, and critical thinking skills to assess available information and render recommendations to create and update edit concepts which, when implemented, may result in identification of improper payments on paid claims on behalf insurers (Clients). Research may include reimbursement regulations, payment guidelines, healthcare provider contracts, and health insurance industry guidance. The position reports to the Director Delivery Services.