Position Overview: 

The Manager, Payment Integrity leads efforts to maximize client adoption of our solutions, drive measurable cost savings, and ensure the accuracy and relevance of data insights. This role manages a team of skilled individual contributors focused on expanding our edit library, uncovering new savings opportunities, and delivering impactful analyses to clients. The ideal candidate combines strong leadership, analytical rigor, and client relationship expertise to advance HealthEdge’s payment integrity goals.

The Product: 

With Source, we’re changing the industry narrative, providing a more holistic approach to payment integrity that focuses on comprehensive reimbursement, agile editing, and integrated analytics. Our interoperable, cloud-based solution is modular to meet a health plan’s needs today and extensible to grow with their organization over time—bringing disparate parts of a payer’s organization together for improved accuracy and insights. The Source platform offers the ability for clients to unlock transformation at the reimbursement, payment integrity, and enterprise level. Our Reimbursement Transformation features Medicare and Medicaid content coupled with flexible contract configuration capabilities for Commercial lines of business. Payment Integrity Transformation includes rich editing libraries with history-based capabilities, easy development of customized edits, and improved transparency to reduce vendor dependency and increase control. As a complete solution, clients can achieve Enterprise Transformation, where root-cause issues are identified and addressed upstream, and all aspects of claims operations are centralized for comprehensive business intelligence. The complete suite of solutions from HealthEdge delivers a digital foundation for payers specifically designed to fuel a digital transformation, reduce costs, and improve both clinical outcomes and the member experience. 

Your Impact: 

• Lead, coach, and mentor a team of analysts responsible for conducting data studies, developing edits, and identifying new savings opportunities 

• Foster team growth and skill development through coaching, feedback, and performance management 

• Oversee and validate data studies to ensure accuracy, quality, and analytical rigor 

• Present data-driven insights and actionable recommendations to clients and internal stakeholders 

• Build strong, trust-based relationships with clients and serve as a strategic advisor on payment integrity initiatives 

• Advocate for the adoption of new content and functionalities to maximize client savings 

• Collaborate with Product, Sales, and Customer Support teams to align on strategy, inform enhancements, and support client expansion 

• Provide strategic input to leadership on the evolution of products, data, and services based on industry and regulatory trends 

• Develop and maintain efficient team processes and standard operating procedures 

• Manage team capacity, prioritization, and performance metrics to meet client and business goals 

• Monitor key performance indicators such as data quality, client adoption, and cost savings achieved 

What You Bring: 

• Bachelor’s degree required; advanced degree preferred 

• 10+ years of experience in healthcare operations, analytics, or payment integrity, with 5+ years leadership experience  

• Deep understanding of claims processing, reimbursement methodologies, and payer operations 

• Strong knowledge of healthcare payment policies, compliance considerations, and regulatory frameworks 

• Proficiency with MS Office, especially Excel, and familiarity with business intelligence and data analysis tools 

• Proven ability to build, develop, and lead high-performing teams 

• Excellent communication, presentation, and interpersonal skills with the ability to influence across all levels 

• Strong analytical, critical thinking, and problem-solving capabilities 

• Strategic mindset with the ability to translate data into actionable insights 

• Self-motivated, adaptable, and results-oriented with a strong sense of ownership and accountability 

• Commitment to collaboration, continuous improvement, and delivering value to clients 

HealthEdge commits to building an environment and culture that supports the diverse representation of our teams. We aspire to have an inclusive workplace. We aspire to be a place where all employees have the opportunity to belong, make an impact and deliver excellent software and services to our customers. 

Geographic Responsibility: While HealthEdge is located in Boston, MA you may live anywhere in the US 
Type of Employment: Full-time, permanent 

Work Environment: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job:  

• The employee is occasionally required to move around the office. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus. 
• Work across multiple time zones in a hybrid or remote work environment. 
• Long periods of time sitting and/or standing in front of a computer using video technology. 
• May require travel dependent on company needs. 

The above statements are intended to describe the general nature and level of the job being performed by the individual(s) assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required. HealthEdge reserves the right to modify, add, or remove duties and to assign other duties as necessary. In addition, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position in compliance with the Americans with Disabilities Act of 1990. Candidates may be required to go through a pre-employment criminal background check. 
 

HealthEdge is an equal opportunity employer. We are committed to workforce diversity and actively encourage all qualified persons to seek employment with us, including, but not limited to, racial and ethnic minorities, women, veterans and persons with disabilities. 

#LI-Remote