• Provides strategic leadership for teams performing advanced, complex claim reviews to ensure accuracy, regulatory compliance, and achievement of payment integrity goals. • This role accelerates program growth by analyzing performance trends, standardizing processes, and implementing consistent review methodologies. • Leveraging deep expertise in ICD-10, CPT/HCPCS coding, and clinical guidelines, the manager delivers actionable insights that shape operational strategies and drive informed decision-making. • Monitoring and optimizing business processes to ensure accuracy, compliance, and integrity in billing and claims payment. • Leads and mentors high-performing teams conducting advanced coding and clinical validation reviews. • Develops and maintains standardized documentation that supports business objectives and ensures consistency in review methodologies and outcomes. • Collaborates with cross-functional stakeholders to identify process improvement opportunities and champion innovative solutions. • Establishes and oversees end-to-end audit program lifecycle within Payment Integrity by setting strategic audit direction, managing and developing teams, and ensuring compliance with all regulatory, contractual, and organizational requirements.