Payment Training Manager at Cohere Health

<p>&nbsp;<strong>Opportunity Overview:</strong></p> <p>We are seeking a versatile and highly skilled Payment Training Manager to join our dynamic Payment Integrity team. This critical role translates Quality Control (QC) feedback and concept development insights into actionable high-impact training programs for our medical audit team to drive accuracy and reduce variance.</p> <p>Ideal candidates should possess a CCS credential, expert knowledge of CPT, HCPCS, and ICD-10-CM/PCS coding guidelines, and a passion for detailed analytical auditing, play a key role in delivering accurate reimbursement solutions and maintaining audit excellence. The ideal candidate is self-motivated, thrives in a remote and fast-paced environment, and is committed to precision, compliance, productivity, and continuous learning within a high-growth organization.</p> <p><strong>What You'll Do:</strong></p> <ul> <li>Translate complex clinical and coding audit concepts into structured training modules.</li> <li>Partner with QC Analyst to isolate systemic auditor knowledge gaps.</li> <li>Convert QC error trends into targeted, remedial education updates.</li> <li>Work with Concept Developers to build training for new audit ideas.</li> <li>Conduct live virtual training sessions and workshops for auditing staff.&nbsp;</li> <li>Measure training impact by tracking post-education QC accuracy scores.</li> <li>Build interactive training materials for both onboarding and continuous learning.</li> <li>Provide clear, constructive, and actionable feedback to auditors to improve quality, productivity, and decision-making accuracy.</li> <li>Drive adoption and effective utilization of Cohere Validate, the internal audit support tool, while providing actionable feedback and enhancement recommendations to improve functionality and audit efficiency.</li> <li>Demonstrate flexibility in using integrated audit technologies, including Encoder, Grouper, and Pricer tools within the internal auditing platform.</li> <li>Stay ahead of industry trends, coding changes, and payment policy updates to maintain expert-level knowledge.</li> <li>Adhere to HIPAA and company policies to ensure data privacy, security, and regulatory compliance.</li> </ul> <p><strong>What You'll Need:&nbsp;</strong></p> <ul> <li>8+ years of overall experience in medical coding, claims auditing, payment integrity, or healthcare reimbursement.</li> <li>Expert knowledge of CPT, HCPCS, ICD-10-CM, modifiers, medical necessity, and reimbursement methodologies.</li> <li>Deep understanding of outpatient claims coding and auditing for Commercial, Marketplace, Medicare, and Medicaid lines of business.</li> <li>Hands-on experience reviewing programs such as HCD, DME, SNF, HH, E&amp;M, Surgery, ASC, Observation, ER, and Infusion claims.</li> <li>Excellent written and verbal English communication skills with ability to deliver clear feedback and training.</li> <li>Proficiency instructional design tools i.e., PowerPoint, Google Slides.</li> <li>Self-motivated and able to work independently in a remote environment while maintaining high performance.</li> <li>Strong time management, organization, and attention to detail.</li> <li>Commitment to collaboration, coaching, continuous learning, and process improvement.</li> <li>Possess CCS (Certified Coding Specialist) credentials.</li> </ul> <p><strong>Nice-to-haves</strong></p> <ul> <li><strong>RHIA</strong> or <strong>RHIT</strong> credential.</li> <li>Experience using <strong>CMS NCDs/LCDs</strong>, payer bulletins, and clinical criteria guidelines.</li> <li>Prior training and education experience.</li> <li>Experience in a high-growth environment with ability to adapt quickly.</li> <li>Familiarity working with diverse, global teams.</li> <li>Strong computer skills and experience working in <strong>Mac</strong> environments.</li> <li>Experience with reporting tools, dashboards, and data-driven quality improvement initiatives.</li> </ul> <p>&nbsp;</p> <p><strong>Pay &amp; Perks:</strong></p> <p>💻 Fully remote opportunity with about 5% travel</p> <p>🩺 Medical, dental, vision, life, disability insurance, and Employee Assistance Program&nbsp;</p> <p>📈 401K retirement plan with company match; flexible spending and health savings account&nbsp;</p> <p>🏝️ Flex Time Off + company holidays</p> <p>👶 Up to 14 weeks of paid parental leave&nbsp;</p> <p>🐶 Pet insurance &nbsp;</p> <p>&nbsp;</p> <p>The salary range for this position is $105,000 to $118,000 annually; as part of a total benefits package which includes health insurance, 401k and bonus. In accordance with state applicable laws, Cohere is required to provide a reasonable estimate of the compensation range for this role. Individual pay decisions are ultimately based on a number of factors, including but not limited to qualifications for the role, experience level, skillset, and internal alignment.&nbsp;</p> <p><strong>Interview Process*:</strong></p> <p>&nbsp;</p> <ol> <li>Connect with Talent Acquisition for a Preliminary Phone Screening</li> <li>Meet your Hiring Manager!</li> <li>Behavioral Interview</li> </ol> <p>&nbsp;</p> <p>*Subject to change</p> <p>&nbsp;</p> <p><strong>About Cohere Health:</strong></p> <p>Cohere Health’s clinical intelligence platform and agentic AI-powered solutions connect health plans’ strategic goals and providers’ needs, optimizing the speed, cost, and quality of care. With an enterprise approach that streamlines payer-provider decision-making across the care continuum–including policy, prior authorization, payment accuracy, and more–the company improves collaboration and reduces burden, resulting in up to 8x ROI and 94% provider satisfaction.&nbsp;</p> <p>With the acquisition of ZignaAI, we’ve further enhanced our platform by launching our Payment Integrity Suite, anchored by Cohere Validate™, an AI-driven clinical and coding validation solution that operates in near real-time. By unifying pre-service authorization data with post-service claims validation, we’re creating a transparent healthcare ecosystem that reduces waste, improves payer-provider collaboration and patient outcomes, and ensures providers are paid promptly and accurately.</p> <p>Cohere Health’s innovations continue to receive industry wide recognition. We’ve been named to the 2025 Inc. 5000 list and in the Gartner® Hype Cycle™ for U.S. Healthcare Payers (2022-2025), and ranked as a Top 5 LinkedIn™ Startup for 2023 &amp; 2024. Backed by leading investors such as Deerfield Management, Define Ventures, Flare Capital Partners, Longitude Capital, and Polaris Partners.&nbsp;</p> <p>The Coherenauts, as we call ourselves, who succeed here are empathetic teammates who are candid, kind, caring, and embody <a href="https://coherehealth.com/our-story">our core values and principles</a>. We believe that diverse, inclusive teams make the most impactful work. Cohere is deeply invested in ensuring that we have a supportive, growth-oriented environment that works for everyone.</p> <p><strong>We can’t wait to learn more about you and meet you at Cohere Health!</strong></p> <p><strong>Equal Opportunity Statement:&nbsp;</strong></p> <p>Cohere Health is an Equal Opportunity Employer. We are committed to fostering an environment of mutual respect where equal employment opportunities are available to all.&nbsp; To us, it’s personal.</p> <p>&nbsp;</p> <p>#LI-Remote</p> <p>#BI-Remote</p>