Payment Integrity Program Development Senior Manager – Clinical & Facility Specialist

As the Senior Payment Integrity Program Development Manager, you will lead the development of innovative clinical claim edit and audit processes at Devoted Health.

Description

• Drive innovation by researching clinical literature and billing trends to identify payment anomalies.
• Author end-to-end logic from scratch based on clinical documentation and coding frameworks.
• Perform data analysis to validate clinical hypotheses and ensure financial viability.
• Pitch clinical concepts to stakeholders and drive consensus across various departments.
• Lead multi-phased concept rollouts from discovery to performance tracking.

Requirements

• Active Registered Nurse (RN) license with direct inpatient clinical experience.
• Active professional coding certification (e.g., CPC, CCS, CCS-P, or RHIA).
• 5+ years of experience in payment integrity as the primary author of claim edits.
• Expert understanding of Medicare rules and billing regulations.
• Deep knowledge of facility and professional billing dynamics.

Benefits

• Dental
• Vision plan with low or no premium
• Generous paid time off.
• $100 monthly mobile or internet stipend.
• Stock options for all employees.
• Bonus eligibility for all roles excluding Director and above.
• Parental leave program.
• 401K program.