Our client, a payment integrity, claims, and audit solutions services company is seeking a dynamic Sales Representative with a strong understanding of healthcare payment integrity concepts and claim processes across Medicare, Medicaid, and Commercial lines of business.

This individual will drive revenue growth by building relationships with health plans, payers, and industry partners, while effectively communicating the value of our solutions.

Responsibilities:

• Proven ability to develop and execute sales strategies for Payment Integrity solutions targeted at health plans and payer organizations.
• Hands-on experience engaging prospects with a strong understanding of:
  • DRG (MS/APR), APC, SNF (PDPM/RUG), Readmission, Cost Outlier, Observation/Short-Stay concepts
  • Ability to differentiate inpatient claims from physician/professional claims during client discussions.
• Demonstrated success positioning solutions that integrate with payer-side claim systems and edit logic (e.g., Pega, Facets, QNXT, HealthEdge) and explaining claims payment flow to decision-makers.
• Deep familiarity with pre-payment vs post-payment audit strategies, vendor models, and regulatory compliance requirements (CMS, OIG, state Medicaid).
• Working knowledge of Fraud, Waste, and Abuse (FWA) programs, analytics-driven savings initiatives, and industry best practices.
• Experience articulating concepts such as COB/Subrogation, SIU, data-mining, and analytics-based savings programs to payer clients.
• Understanding of end-to-end Payment Integrity processes, including:
  • Pre/post-payment adjudication
  • Medical record requests
  • Provider collection letters
  • Recoupment/refund checks
  • Dispute/appeals handling
  • Client invoicing
• Proven track record building relationships with health plan decision-makers and navigating complex payer organizations.
• Full sales cycle management experience, including prospecting, presentations, proposals, negotiations, and closing deals.

Qualifications:

• Experience: 3+ years in healthcare sales, preferably in payment integrity, claims, or audit solutions.
• Knowledge:
  • Medicare, Medicaid, and Commercial claim structures
  • PI concepts and vendor landscape
• Skills:
  • Strong communication and presentation abilities
  • Ability to explain technical concepts clearly to non-technical audiences
  • Proven track record of meeting or exceeding sales targets
• Familiarity with vendors such as Cotiviti, HMS, Optum, etc.
• Understanding of SIU, COB/Subrogation, and analytics-based programs
• Existing relationships within health plans or payer organizations

Company Location: Saddle River NJ
Job Location: Remote – requires travel to conferences and trade shows
Salary: $180K

Compensation: $180,000