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Senior Manager, Payment Integrity, Provider Escalation
Devoted Health. Direct, mentor, and oversee the Payment Integrity disputes and appeals delivery team .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates extensive expertise in healthcare payment integrity, including mastery of CMS regulations, CPT, HCPCS, and ICD-10 coding. Proven ability to manage operational metrics and lead cross-functional teams while resolving complex provider disputes and escalations.
Highest-signal resume keywords
Healthcare Payment IntegrityCMS Regulations MasteryCPT/HCPCS/ICD-10 ExpertiseOperational Metrics ManagementConflict Resolution Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims Data AnalysisCoding/Clinical Documentation ReviewDispute ManagementQuality AssuranceSLA Compliance
Soft Skills
Cross-Functional CollaborationExecutive Presentation SkillsMentoring
Tools & Technologies
SQLTableauPower BIAI ToolsRPA
Certifications & Qualifications
AAPC CertificationAHIMA CertificationCPCCICCOC
Industry Keywords
Provider Dispute ManagementClaim Audit OperationsBilling GuidelinesReimbursement PoliciesNCCI Edits
Tech Stack
Tools & technologiesRPASQLTableau
About the role
Key responsibilities & impact- Direct, mentor, and oversee the Payment Integrity disputes and appeals delivery team
- Manage daily queue health, turnaround times, quality assurance, and SLA compliance across claim disputes and escalations
- Serve as the subject matter expert on billing guidelines, reimbursement policies, and CMS regulations
- Act as the primary escalation point for high-complexity claims
- Perform granular trend analyses of dispute data, including CPT/HCPCS codes, modifiers, billing taxonomy, facilities, and regions
- Identify billing errors, volume spikes, and system or policy root causes
- Translate dispute and appeal insights into recommendations for upstream payment integrity edit and audit teams
- Represent dispute performance to senior leadership through operational reporting and trend updates
- Resolve high-priority provider escalations
- Maintain documentation logs, SOPs, and quality control frameworks for audit readiness
- Collaborate with clinical, coding, and operational teams on provider billing guidance and education
- Identify opportunities to use AI tools, automation, and LLM-assisted workflows to improve research and operational throughput
Requirements
What you’ll need- 5+ years of healthcare payment integrity, provider dispute management, coding/clinical documentation review, or claim audit operations experience
- 3+ years of supervisory or people management experience
- Extensive mastery of CMS regulations governing Medicare Advantage disputes, organization determinations, and auditing protocols
- Expert-level knowledge of CPT, HCPCS, ICD-10, UB-04, NCCI edits, and NCD/LCD guidelines
- Ability to manage operational metrics, queue throughput, and team performance while serving as a high-level SME for complex medical record reviews and coding/clinical determinations
- Strong analytical background in synthesizing claims data, research findings, and medical records
- Exceptional cross-functional collaboration and executive presentation skills
- Active medical coding certification from AAPC or AHIMA (e.g., CPC, CIC, COC, or RHIA/RHIT) desired
- Hands-on experience or familiarity with LLMs, AI-driven claim intake tools, or RPA desired
- Familiarity with SQL, Tableau, Power BI, or claim editing engine logic such as Cotiviti, Optum, or Change Healthcare desired
- Prior Provider Relations or Network Management experience desired
- Proven conflict resolution skills for complex, high-dollar, or executive-level provider escalations
- Practical experience or strong curiosity and hands-on aptitude with AI tools, automation, and LLM-based workflows desired
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
- Parental leave program
- 401K program