Director, Account-Based Experience
Baxter Planning
Claims & Payments Director
Devoted Health
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteSalary
💰 $225,000 - $300,000 per year
Job Level
Lead
About the role
- Interface directly with providers , particularly health systems, on claims policies and claims disputes.
- Lead our Payment Policy Committee (PPC) and serve as our lead expert on claims and payment regulations, offering policy and implementation recommendations that are compliant and balance commercial, relationship, and operational goals
- Serve on our Contract Committee and review all provider contracts brought to the Committee, flagging any non-favorable, vague, non-compliant, or operationally unfeasible payment terms.
- Review complex claims, making clear and reasonable adjudication decisions while also setting policy and precedence for other similar claims.
Requirements
- 10 + years of Deep claims expertise with a strong understanding of U.S. healthcare, Medicare Advantage, health system ecosystem, revenue cycle management, utilization management, and payment integrity
- Demonstrated mastery of claims policy and adjudication gained from extensive experience at a large-scale payer, where you tackled the most complex reimbursement challenges.
- Strong functional expertise in Medicare Advantage health plan operations, with a deep understanding of its key financial drivers, healthcare delivery systems, payment methodologies, and regulatory frameworks.
- Deep knowledge of medical coding (CPT, HCPCS Level II, ICD-10-CM/PCS) is a significant plus.
- Outstanding communication skills and linear thinking.
- Facile with technology; must be able to learn our tech system and be able to independently interpret claims, pull reports, run analyses.
- AI and automation proficiency with curiosity about emerging technologies.
- Fast-paced self starter.
- Comfortable operating in both leadership and execution roles.
- Demonstrated leadership impact and collaborative excellence.
Benefits
- Employer sponsored health, dental and vision plan with low or no premium
- Generous paid time off
- $100 monthly mobile or internet stipend
- Stock options for all employees
- Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles
- Parental leave program
- 401K program
- And more....
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
claims expertiseclaims policyadjudicationMedicare Advantagerevenue cycle managementutilization managementpayment integritymedical codingCPTICD-10-CM
Soft skills
communication skillslinear thinkingself-starterleadershipcollaborative excellence
