Director, Payment Integrity

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Devoted Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2017

⚕️ Healthcare Insurance

🧘 Wellness

Healthcare Insurance • Wellness

Devoted Health is a healthcare company that offers Medicare Advantage plans designed to provide comprehensive health coverage with added benefits like dental, eyewear, gym memberships, and prescription drugs at competitive rates. The company emphasizes member support and service, ensuring that clients can easily navigate their benefits and access needed healthcare services. Devoted Health is committed to helping customers save money and enhance their health and wellness through a complete package of benefits and support.

📋 Description

• 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.

🎯 Requirements

• 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.

🏖️ Benefits

• 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....