CGI Veterans Jobs

Job Information

CGI Technologies and Solutions, Inc. New Concepts and Edits Development Manager in Cleveland, Ohio

New Concepts and Edits Development Manager

  • Create your Profile | Sign in

  • Activate Career Alerts

Share this

Find similar career opportunities

New Concepts and Edits Development Manager

Category: Business Analysis (functional and technical)

City: Cleveland, Ohio, US United States

Position ID: J1221-2729

Employment Type: Full Time

Position Description:

The New Concepts and Edits Manager is a member of the CGI Payment Integrity Department, with leadership and management responsibility of the Edit Team which is charged with identifying new concepts and edits for the purpose of creation of payment integrity audits. The New Concepts and Edits Manager is charged with researching reimbursement regulations, payment guidelines, healthcare provider contracts, and health insurance industry guidance’s to create edit concepts which when implemented may result in identification of improper payments on paid claims on behalf insurers (Clients).

The New Concepts and Edits Manager has a sound knowledge base in edit research and development in pre-pay and retrospective medical claims auditing. Edits are developed through a well-defined process which requires the Edit Manager to incorporate clinical experience, knowledge, and critical thinking skills in order to assess available information and render recommendations. The New Concepts and Edits Manager reports to the Director, Payment Integrity, who provides support, feedback, and guidance to the Edit Manager.

Your future duties and responsibilities:

• Work closely with Artificial Intelligence teams (either vendor or CGI internal) to further streamline the edit development processes.

Required qualifications to be successful in this role:

• Manages a team of 4-6 edit development specialists who are responsible for the development and implementation of new edits and auditing tools to ensure a viable quantity and high quality of audits are available for payment integrity review.

• Performs all Human Resources required management tasks in regards to the Edit Team members in a timely, professional and positive manner. (e.g. interviewing, hiring, evaluating, setting expectations, monitoring, development and discipline of team members as required).

• Develops successful audit scenarios for all provider types; facilitates documentation request schedules that maximize member performance levels while ensuring timeliness based on client requirements.

• Ensures that all edit development activities are conducted within the time frame stipulated by client contracts and service level agreements.

• Works with Audit Team leaders and team members to provide meaningful insights, timely feedback, and recommendations for Edit development

• Serves as a Chairperson of the Edit Development Team

• Develops and issues client-specific reports on edit development in an accurate and timely fashion.

• Works with the internal ProperPay developers to test and create edits within ProperPay.

• Effectively responds to issues and concerns raised by internal and external clients.

• Participates in and supports new client projects as required.

• Attend internal and external client meetings as required.

• Monitors all team members to ensure they are managing their time and assignments in an effective and efficient manner.

• Provides meaningful and timely feedback to the Edit and audit teams to improve the quality of audit and appeal determinations.

• Contributes to solution strategies and roadmaps for product and process improvements

• Ensure high quality deliverables on schedule and within budget

• Performs other duties as assigned

Minimum Education Required: Associates Degree (RHIT); Bachelors degree preferred and at least one of the following professional certifications: CCS-P, CPC, CPC-H/COC


The New Concepts and Edits Manager is a Registered Nurse (RN) with active, unrestricted licensure through the Board or Agency charged with providing such licensure in the Auditor’s state of residence or RHIA/RHIT/CCS certified through the American Health Information Management Association. Previous pre-pay or post-payment auditing and edit development experience required (Minimum 5 years). Previous supervisory or management role (3 years minimum) in audit field required.

Professional, organized and able to communicate effectively.

Has strong working knowledge of CMS, Medicaid and Commercial (payer) reimbursement methods and systems and guidelines and payment methodologies.

Must have good working knowledge and experience of the different types of payment structures (fee schedule, POC, etc.) and how those can influence recovery opportunities.

Must have strong understanding of recovery audit edit development from both a pre and post payment perspective for both complex and automated reviews.

Est. Salary Range (Colorado Only): $84k-$138k*

*Disclaimer: In accordance with Colorado’s Equal Pay for Equal Work Act, effective January 1, 2021, a good faith hourly or base salary range must be posted for all positions where the work may be performed in the state of Colorado. Therefore, this good faith salary range will only apply where this described position will be performed in the state, and should not be considered the compensation range in other locations or for other positions.

At CGI we call our professionals members to reinforce that all who join our team are, as owners, empowered to participate in the challenges and rewards that come from building a world-class company. CGIs benefits include:

Competitive base salaries

Eligibility to participate in an attractive Share Purchase Plan (SPP) in which the company matches dollar-for-dollar contributions made by eligible employees, up to a maximum, for their job category

401(k) Plan and Profit Participation for eligible members

Generous holidays, vacation, and sick leave plans

Comprehensive insurance plans that include, among other benefits, medical, dental, vision, life, disability, out-of-county emergency coverage in all countries of employment;

Back-up child care, Pet insurance, a Member Assistance Program, a 529 college savings program, a personal financial management tool, lifestyle management programs and more



  • Auditing (Claims)

  • Registered Nurse (RN)

  • Supervisory Audits Support

What you can expect from us:

Build your career with us.

It is an extraordinary time to be in business. As digital transformation continues to accelerate, CGI is at the center of this change—supporting our clients’ digital journeys and offering our professionals exciting career opportunities.

At CGI, our success comes from the talent and commitment of our professionals. As one team, we share the challenges and rewards that come from growing our company, which reinforces our culture of ownership. All of our professionals benefit from the value we collectively create.

Be part of building one of the largest independent technology and business services firms in the world.

Learn more about CGI at .

No unsolicited agency referrals please.

CGI is an equal opportunity employer.

Qualified applicants will receive consideration for employment without regard to their race, ethnicity, ancestry, color, sex, religion, creed, age, national origin, citizenship status, disability, pregnancy, medical condition, military and veteran status, marital status, sexual orientation or perceived sexual orientation, gender, gender identity and gender expression, familial status, political affiliation, genetic information, or any other legally protected status or characteristics.

CGI provides reasonable accommodations to qualified individuals with disabilities. If you need an accommodation to apply for a job in the U.S., please email the CGI U.S. Employment Compliance mailbox at . You will need to reference the requisition number of the position in which you are interested. Your message will be routed to the appropriate recruiter who will assist you. Please note, this email address is only to be used for those individuals who need an accommodation to apply for a job. Emails for any other reason or those that do not include a requisition number will not be returned .

We make it easy to translate military experience and skills! Click here to be directed to our site that is dedicated to veterans and transitioning service members.

All CGI offers of employment in the U.S. are contingent upon the ability to successfully complete a background investigation. Background investigation components can vary dependent upon specific assignment and/or level of US government security clearance held. Qualified applicants with arrest and conviction records are welcome to apply.

CGI will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with CGI’s legal duty to furnish information.