Inpatient Payment Integrity Lead – Audit & Compliance

Devoted; Northern (KY); Remoto; USD 73.000 - 120.000; Tempo pieno

Vantaggi offerti da questo lavoro

Health, dental and vision plan

Generous paid time off

$100 monthly mobile stipend

Stock options for all employees

Bonus eligibility

Descrizione del lavoro

Devoted Health is seeking a Payment Integrity Inpatient Program Manager to oversee audit, appeals, and quality across programs, including offshore support and external vendors. This role ensures SLA adherence and defensible audit determinations.

You will guide staff, develop training materials, monitor metrics, and drive improvements while collaborating with leadership and operations to maintain regulatory compliance and accurate DRG coding.

Competenze

• 2-3 years of experience in healthcare audit, Payment Integrity, coding review, clinical documentation review, or compliance.
• Strong inpatient coding knowledge required; CCS, RHIA, RHIT, RN, or equivalent inpatient coding/clinical validation experience.
• Experience with inpatient DRG assignment and validation, including ICD-10-CM coding and readmission logic.

Mansioni

• Perform complex inpatient Payment Integrity audits including clinical validation and DRG coding validation.
• Provide guidance to internal staff and external vendors, managing calibration, feedback, and quality monitoring.
• Develop and maintain program-specific training materials, audit guidance, and documentation.
• Perform quality reviews and trend analysis to ensure accuracy and defensibility of findings.
• Monitor program metrics, dispute trends, and vendor results, identifying root causes for improvement.
• Collaborate with stakeholders to resolve complex audit, coding, and escalation issues.
• Support dispute and appeals management activities, including escalation review and corrective actions.
• Support implementation of new audit concepts and methodologies.

Conoscenze

Inpatient coding

Audit quality

Clinical documentation

Data analysis

Vendor management

Regulatory compliance

Formazione

Bachelor’s Degree

Descrizione del lavoro

Devoted Health is seeking a Payment Integrity Inpatient Program Manager to oversee audit, appeals, and quality across programs, including offshore support and external vendors. This role ensures SLA adherence and defensible audit determinations.

You will guide staff, develop training materials, monitor metrics, and drive improvements while collaborating with leadership and operations to maintain regulatory compliance and accurate DRG coding.