Payment Integrity Program Manager

📋 Description

• Perform complex and escalated inpatient Payment Integrity audits, including clinical validation
• Provide oversight and guidance to stateside and offshore teams and external vendors through
• Develop and maintain program-specific training materials, audit guidance, review standards, and
• Conduct quality reviews and trend analysis to verify coding, clinical, and audit findings and
• Monitor program metrics, dispute trends, turnaround performance, and vendor results, identifying
• Serve as a subject matter expert for assigned programs, partnering with clinical, coding, audit

🎯 Requirements

• 2-3 years of experience in healthcare auditing, Payment Integrity, coding review, clinical
• Strong clinical and inpatient coding expertise, with CCS, RHIA, RHIT, RN, or equivalent inpatient
• Demonstrated expertise in inpatient DRG assignment and validation, including ICD-10-CM coding
• Experience reviewing medical records to assess audit accuracy, coding and clinical correctness
• Experience working within structured audit programs, applying defined criteria, documenting
• Ability to interpret clinical and coding documentation, identify documentation gaps or

🎁 Benefits

• Employer-sponsored health, dental, and vision coverage with low or no employee premiums
• Generous paid time off
• $100 monthly mobile or internet stipend
• Stock options for eligible employees
• Bonus eligibility for applicable roles
• Parental leave program