Director, Payment Integrity Innovation & Programs

Sagility Payment Integrity Solutions LLC

United States

Remote

USD 120,000 - 180,000

Full time

14 days+

Application generator

Don’t send a generic resume — generate a resume and cover letter tailored to this exact role.

Get past ATS filters

Job summary

Sagility is seeking a Manager, Payment Integrity Program Development & Innovation to lead a team of experts in designing, implementing, and optimizing complex audit programs that identify and recover healthcare overpayments across inpatient, outpatient, professional, and DME claims.

You will partner with clinical, analytics, operations, and client services teams to drive innovative audit solutions, maximize recovery opportunities, and ensure program effectiveness while aligning with regulatory

Qualifications

Bachelor’s degree in a related field is required.
Minimum of 5 years of healthcare Payment Integrity experience.
At least 3 years of leadership experience managing audit, coding, clinical, payment integrity, or SME teams.
Experience developing complex healthcare audit concepts and claim selection methodologies.
Strong knowledge of reimbursement methodologies and coding systems.
Ability to collaborate with analytics, operations, and appeals teams.

Responsibilities

Lead a team of SME experts responsible for complex audit program design and implementation.
Develop and maintain a portfolio of audit concepts and recovery initiatives.
Collaborate with analytics to design, validate, and optimize claim selection methodologies.
Ensure regulatory, contractual, and operational compliance.
Partner with cross‑functional teams for client‑facing program strategy.