Senior Manager, Payment Integrity Program Development

Devoted Health

. Manage assigned internal and vendor-supported payment integrity programs across implementation, monitoring, maintenance, and ongoing operational support .

Posted 10/30/2026full-timeRemote • United StatesSenior💰 $110,500 - $150,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates strong expertise in healthcare claims and payment integrity, with a proven ability to lead complex initiatives and drive operational improvements. Proficient in analyzing claims data and collaborating with cross-functional teams to implement effective solutions.

Highest-signal resume keywords

Healthcare Claims ExpertisePayment Integrity Program ManagementRoot Cause AnalysisSQL ProficiencyCross-Functional Collaboration

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Payment IntegrityClaims EditingReimbursementOperational Performance ImprovementAnalytical LiteracyTechnical ConfigurationData InterpretationWorkflow AutomationPerformance MonitoringVendor Management

Soft Skills

Strong CommunicationPrioritizationInfluencing SkillsIndependent JudgmentProblem-Solving

Tools & Technologies

AI-Enabled Analytical ToolsSQLOperational MetricsClaims Information SystemsPerformance Trends Analysis

Industry Keywords

Healthcare Revenue CycleCMS GuidanceNCCI FrameworksMedicare AdvantageClaims Adjudication

Tech Stack

Tools & technologies

SQL

About the role

Key responsibilities & impact

Manage assigned internal and vendor-supported payment integrity programs across implementation, monitoring, maintenance, and ongoing operational support
Establish priorities, coordinate resources, and ensure effective execution
Evaluate program performance, including savings, hit rates, yield, turnaround times, and provider impacts
Identify trends, emerging risks, and opportunities for improvement
Investigate complex claims, configuration, and operational issues; determine root causes and impact; develop evidence-based recommendations; and drive resolution across functions
Partner with clinical, coding, and reimbursement SMEs to translate concept logic into clear implementation requirements
Collaborate with Engineering, Product, Data Science, and operational teams to support configuration, testing, deployment, and troubleshooting
Coordinate portfolio maintenance, backsweeps, performance monitoring, regulatory updates, and compliance-related activities
Ensure appropriate controls, documentation, escalation, and follow-through
Identify recurring inefficiencies, capacity constraints, and operational risks
Partner with department leadership to evaluate and implement workflow, resource allocation, automation, and technology improvements
Use claims information, operational metrics, analytical tools, and performance trends to investigate issues, evaluate opportunities, and inform recommendations
Bring together stakeholders across Payment Integrity, Claims, Compliance, Engineering, Product, and Data Science to achieve measurable outcomes
Independently lead complex, multi-phase initiatives, manage competing priorities and dependencies, and strengthen repeatable processes, knowledge sharing, and cross-coverage

Requirements

What you’ll need

Bachelor's degree and a minimum of 6 years of relevant professional experience within a health plan, payment integrity vendor, healthcare revenue cycle environment, or related healthcare setting
Strong expertise in healthcare claims, payment integrity, claims editing, reimbursement, or related healthcare payment operations
Demonstrated experience implementing, validating, maintaining, or optimizing payment integrity edits, audits, claims logic, or comparable healthcare operational programs
Demonstrated ability to independently investigate complex claims or operational issues, perform root cause analysis, and translate findings into actionable solutions
Strong analytical literacy, including the ability to interpret claims data, operational metrics, technical findings, and performance trends
Demonstrated ability to lead complex, multi-phase initiatives across multiple functions with limited oversight
Strong independent judgment and ability to develop recommendations where data, policy, or operational signals may be incomplete or ambiguous
Strong communication, prioritization, and influencing skills, including the ability to align cross-functional partners and drive work through resolution
Experience with Medicare Advantage and prospective and/or retrospective payment integrity programs
Experience working with Engineering, Product, or technical configuration teams to implement and troubleshoot claims editing logic
Familiarity with CMS guidance, NCCI frameworks, reimbursement policies, coding requirements, and healthcare claims adjudication
Experience managing vendor-supported programs, validation operations, maintenance processes, or operational performance improvement
Experience using SQL, AI-enabled analytical tools, automation, or other technology to improve payment integrity workflows and performance

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