Provider Education Program Manager – Payment Integrity

E-Verify Program

Provider Education Program Manager overseeing healthcare billing education for Blue Cross NC. Responsible for developing educational programs to address provider billing patterns and compliance.

Posted 6/12/2026full-timeDurham • Kentucky, Louisiana, Mississippi, North Carolina, South Carolina • 🇺🇸 United StatesSeniorLead💰 $107,901 - $172,642 per yearWebsite

About the role

Key responsibilities & impact

Develop and maintain the health plan’s provider education program for coding, documentation, and billing integrity issues
Establish program workflows, referral criteria, outreach templates, monitoring schedules, escalation pathways, and reporting standards
Create standardized processes for provider identification, educational intervention, follow-up review, and referral to SIU when concerning behavior persists
Analyze claims, coding, utilization, reimbursement, and provider billing data to identify outlier patterns
Conduct targeted reviews to determine whether provider billing patterns warrant education or further escalation
Draft and issue provider education letters that clearly describe identified billing concerns
Conduct provider outreach calls and meetings to review findings, explain coding or documentation expectations, answer questions
Perform quarterly and semiannual post-education monitoring to assess whether provider billing behavior changes
Develop and administer a formal referral process to SIU for providers whose billing patterns do not improve

Requirements

What you’ll need

Bachelor's degree or advanced degree (where required)
8+ years of experience in related field. In lieu of degree, 10+ years of experience in related field.
CPC, CCS (Required), CEMA, CPMA (Strongly Preferred), CPIP (Nice to have) or similar coding/compliance certification.
Experience in managed care, Medicare, Medicaid, Marketplace, or commercial health plan operations.
Experience with provider education, payment integrity vendor outputs, post-pay review, overpayment recovery, or FWA/SIU workflows.
Advanced Excel, dashboarding, and data visualization skills.
Strong knowledge of CPT, HCPCS, ICD-10, modifiers, documentation standards, reimbursement methodology, CMS guidance, and payer billing requirements.

Benefits

Comp & perks

Medical, dental, and vision coverage along with numerous health and wellness programs
Parental leave and support plus adoption and surrogacy assistance
Career development programs and tuition reimbursement for continued education
401k match including an annual company contribution
Work-life balance, flexibility, and the autonomy to do great work

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

codingdocumentationbilling integrityclaims analysisdata visualizationCPTHCPCSICD-10reimbursement methodologypayer billing requirements

Soft Skills

communicationorganizationalanalyticaleducational interventionoutreachmonitoringreportingescalationprovider engagementproblem-solving

Certifications

CPCCCSCEMACPMACPIP