Payment Integrity Program Manager

Devoted Health

. Oversee assigned inpatient Payment Integrity programs, including audit, appeals, quality, and review processes across internal teams, offshore staff augmentation, and external vendors .

Posted 10/6/2026full-timeRemote • United StatesJuniorMid-Level💰 $73,000 - $120,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Inpatient Payment Integrity Audits, including DRG Coding Validation and Clinical Documentation Review, while ensuring Regulatory Compliance and Audit Accuracy. Capable of developing training materials and collaborating with diverse teams to drive continuous improvement in audit processes.

Highest-signal resume keywords

Inpatient Payment Integrity AuditsDRG Coding ValidationClinical Documentation ReviewCCS, RHIA, RHIT, RN CertificationAudit Accuracy and Compliance

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Inpatient Coding KnowledgeICD-10-CM CodingAudit Rationale DocumentationQuality Review and Trend AnalysisRoot Cause Analysis

Soft Skills

LeadershipCommunicationInterpersonal SkillsOrganizational SkillsAnalytical Skills

Tools & Technologies

AI ToolsAutomationLLM-Based Workflows

Certifications & Qualifications

CCSRHIARHITRN

Industry Keywords

Healthcare AuditPayment IntegrityComplianceClinical ValidationAudit Programs

About the role

Key responsibilities & impact

Oversee assigned inpatient Payment Integrity programs, including audit, appeals, quality, and review processes across internal teams, offshore staff augmentation, and external vendors
Ensure audit accuracy, timeliness, coding and clinical quality, regulatory compliance, consistency, and defensibility
Perform complex and escalated inpatient Payment Integrity audits, including clinical validation, DRG coding validation, readmission, and hospital bill audit reviews
Provide clear, defensible audit rationale and determinations
Provide guidance and oversight to internal staff and external vendors through calibration sessions, feedback loops, education, and ongoing quality monitoring
Develop and maintain program-specific training materials, audit guidance, review standards, and supporting documentation
Perform quality reviews and trend analysis of coding, clinical, and audit findings
Monitor program metrics, dispute trends, and vendor results; identify root causes and drive continuous improvement
Collaborate with internal and external stakeholders to resolve complex audit, coding, clinical, and escalation-related issues
Serve as the primary subject matter expert for assigned program areas
Support dispute and appeals management, including escalation review, audit rationale review, and corrective action planning
Support implementation of new audit concepts, review methodologies, and program enhancements

Requirements

What you’ll need

2-3 years of experience in healthcare audit, Payment Integrity, coding review, clinical documentation review, or compliance
Strong clinical and inpatient coding knowledge required
CCS, RHIA, RHIT, RN, or equivalent inpatient coding/clinical validation experience required
Demonstrated expertise in inpatient DRG coding and validation strongly preferred
Demonstrated experience with inpatient DRG assignment and validation, including ICD-10-CM coding, principal and secondary diagnosis assignment, MCC/CC identification, POA indicators, inpatient clinical documentation review, severity of illness/risk of mortality concepts, and readmission logic
Demonstrated experience reviewing medical records for audit accuracy, coding/clinical correctness, compliance, and defensibility
Experience operating within structured audit programs, applying defined criteria, documenting rationale, and ensuring consistency and quality of audit outcomes
Ability to interpret clinical and/or coding documentation to support audit decisions and resolve documentation gaps or discrepancies
Experience collaborating across clinical, coding, audit, and operational teams in a complex healthcare environment
Strong analytical skills for assessing audit trends, root causes, and documentation gaps
Strong operational discipline and ability to stay organized amidst varied responsibilities
Proven experience in training payment integrity audits
Bachelor’s Degree desired
Strong leadership, communication, and interpersonal skills
Experience managing offshore vendors
Ability to handle multiple priorities and meet deadlines in a fast-paced environment
Curiosity and hands-on experience with AI tools, automation, or LLM-based workflows in operational settings

Benefits

Comp & perks

Employer sponsored health, dental and 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
Commission eligibility for Sales roles
Parental leave program
401K program