Director, Payment Integrity

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Devoted Health

SiteLinkedInTodas as Vagas

1001 - 5000 funcionários

Fundada em 2017

⚕️ Seguro de Saúde

🧘 Bem-estar

Healthcare Insurance • Wellness

A Devoted Health é uma empresa de saúde que oferece planos Medicare Advantage projetados para fornecer cobertura de saúde abrangente com benefícios adicionais como cuidados dentários, óculos, associações a academias e medicamentos prescritos a preços competitivos. A empresa enfatiza o suporte e serviço ao membro, garantindo que os clientes possam navegar facilmente por seus benefícios e acessar os serviços de saúde necessários. A Devoted Health está comprometida em ajudar os clientes a economizar dinheiro e melhorar sua saúde e bem-estar por meio de um pacote completo de benefícios e suporte.

Descrição

• Serve as the primary Subject Matter Expert (SME) for payment integrity initiatives. • Provide clinical, coding, and technical rationales for audit programs to Compliance, Network Management, and Operations leadership to ensure total organizational alignment and policy defensibility. • Provide clinical and coding expertise to provider-facing teams for complex inquiries. • Perform deep-dive reviews of escalations to identify root causes. • Offer technical and clinical guidance to the teams handling audits and disputes. • Lead the development of internal 'best practice' guides and clinical logic resources. • Collaborate with the Network team to ensure contract language reflects current clinical coding standards and work with Compliance to maintain the highest levels of program integrity.

🎯 Requisitos

• Must hold an active Registered Nurse (RN) license and/or Certified Professional Coder (CPC/CPMA) designation • 8+ years in healthcare payment integrity, medical audit, or revenue cycle leadership • Proven ability to present complex clinical or coding rationales to executive leadership • Experience resolving high-stakes technical disputes through clinical authority and mastery of payment policy • Proven track record of leading teams and mentoring staff to drive successful program outcomes • Comfort with emerging technologies and a strong willingness to adopt an 'AI-first' mindset to optimize workflows and audit logic • Thrives in a fast-paced, high-growth, or start-up environment; highly comfortable navigating ambiguity and evolving business needs.

🏖️ Benefícios

• 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 • And more....