Senior Manager, Payment Integrity Program Development

🔥 14 hours ago

🇺🇸 United States – Remote

💵 $110.5k - $150k / year

⏰ Full Time

🟠 Senior

👔 Manager

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Devoted Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2017

🏥 Healthcare

⚕️ Healthcare Insurance

🧘 Wellness

Healthcare • 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

• 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

• 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

• 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

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