Director, Payment Integrity: Lead AI-Driven Audit Strategy

Neara; Northern (KY); Hybrid; USD 180,000 - 240,000; Full time

Benefits offered by this job

Competitive compensation package

Medical, Dental and Vision benefits

Flexible, paid vacation policy

Direct access to Leadership

Job summary

Alaffia is seeking a Director, Payment Integrity to own the strategy, performance, and scale of our payment integrity review programs, including IBR and DRG validations. You will lead Managers and a broader team of Medical Bill Reviewers/Analysts, translating client priorities into execution and serving as the senior clinical authority for Payment Integrity across the company.

This role will build process, set standards for audit accuracy, throughput, and client savings, and collaborate with

Qualifications

• 8+ years in medical bill review or payment integrity.
• Experience leading managers or multi-team groups.
• Knowledge of CPT/ICD-10/HCPCS coding guidelines.
• Excellent communication to executives and stakeholders.

Responsibilities

• Own the end-to-end program strategy for Payment Integrity, including IBR and DRG audit workstreams.
• Lead and develop a team of Managers and reviewers, setting performance standards.
• Establish escalation paths for high-complexity cases and ensure defensible audit findings.
• Own KPI framework for accuracy, throughput, SLA, and client savings metrics.
• Represent the program in planning, budgeting, and leadership discussions.
• Partner with Product/Engineering on AI/automation integration while preserving clinical defensibility.

Skills

Program management

Leadership

KPI & metrics

Client relationship management

Education

RN license or higher

Job description

Alaffia is seeking a Director, Payment Integrity to own the strategy, performance, and scale of our payment integrity review programs, including IBR and DRG validations. You will lead Managers and a broader team of Medical Bill Reviewers/Analysts, translating client priorities into execution and serving as the senior clinical authority for Payment Integrity across the company.

This role will build process, set standards for audit accuracy, throughput, and client savings, and collaborate with