Senior Payment Integrity Program Development Manager – Operational Excellence

🔥 13 hours ago

🇺🇸 United States – Remote

💵 $110.5k - $150k / year

⏰ Full Time

🟠 Senior

⚙️ Operations

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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

• Evaluate the effectiveness of payment integrity edits and audits, investigate complex performance or operational issues, identify root causes, and drive improvements in accuracy, financial outcomes, and provider experience • Ensure new and modified payment integrity programs are appropriately validated and implemented as intended • Partner with technical and operational teams to strengthen testing, quality controls, and implementation reliability • Lead assigned internal and vendor-supported portfolio activities, including prioritization, issue resolution, maintenance, and ongoing program performance • Identify and implement improvements to processes, workflows, and supporting capabilities across validation, monitoring, maintenance, and knowledge sharing • Leverage technology, automation, and operational best practices to improve efficiency, transparency, and scalability • Advance complex initiatives, develop evidence-based recommendations, and build alignment across Payment Integrity, Engineering, Data Science, Claims, Compliance, and other stakeholders

🎯 Requirements

• Bachelor's degree and 6+ years of relevant professional experience, including substantial hands-on payment integrity experience within a health plan or payment integrity vendor • Strong understanding of healthcare claims, payment integrity edits and audits, claims adjudication, Medicare/CMS reimbursement policies, NCCI/CCI edits, and supporting operational processes • Demonstrated ability to investigate complex payment integrity issues, analyze root causes, and drive effective resolution • Strong analytical and technical literacy, including the ability to read and interpret SQL queries, claims data, configuration specifications, validation results, and performance metrics • Proven experience designing and implementing operational improvements, scalable workflows, or technology-enabled solutions that deliver measurable results • Demonstrated ability to independently explore and apply analytical tools, technology, and automation to improve workflows, identify opportunities, and develop scalable operational solutions • Experience collaborating with technical and operational partners to implement, troubleshoot, or improve payment integrity programs • Demonstrated ability to independently lead complex, multiphase initiatives, exercise sound judgment, and influence cross-functional stakeholders • Experience with Medicare Advantage and Commercial payment integrity programs • Experience with vendor-supported claims editing platforms or proprietary payment integrity solutions • Professional coding certification (e.g., CPC, CCS) or comparable reimbursement expertise • Experience implementing AI-enabled analytics, automated testing, performance monitoring, or workflow automation to improve payment integrity operations

🏖️ 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 • Parental leave program • 401K program

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