Inpatient Payment Integrity Lead — Remote

Devoted Health Services, Inc; Waltham (MA); On-site; USD 73,000 - 125,000; Full time

Benefits offered by this job

Health, dental and vision plan

Generous paid time off

$100 monthly mobile stipend

Stock options

Bonus eligibility for all roles

Parental leave program

401K program

Job summary

Devoted Health Services, Inc. seeks an experienced Payment Integrity Inpatient Program Manager to oversee inpatient audits, DRG coding validation, and quality across internal teams and external vendors. You will ensure timely audits, defensible determinations, and strong SLA adherence while managing offshore and onshore resources.

The role emphasizes leadership in audit accuracy, regulatory compliance, and program enhancements to meet evolving healthcare requirements and Customer care standards.

Qualifications

• 2-3 years of experience in healthcare audit, Payment Integrity, coding review, clinical documentation review, or compliance.
• Strong clinical and inpatient coding knowledge with relevant credentials.
• Experience with inpatient DRG coding and validation preferred.
• Experience reviewing medical records to ensure audit accuracy and defensibility.

Responsibilities

• Perform complex inpatient Payment Integrity audits with defensible rationale.
• Provide guidance to internal staff and external vendors, maintaining quality and SLAs.
• Develop training materials and audit guidance for the program.
• Conduct quality reviews and trend analyses to ensure accuracy and compliance.
• Monitor metrics and vendor performance, driving continuous improvement.
• Collaborate with stakeholders to resolve audit, coding, and escalation issues.
• Support dispute and appeals management and action planning.
• Assist with new audit concepts and program enhancements.

Skills

Healthcare audit

Payment Integrity

Coding review

Clinical documentation review

Regulatory compliance

Audit quality

Vendor management

Training audits

Education

Bachelor’s Degree

Job description

Devoted Health Services, Inc. seeks an experienced Payment Integrity Inpatient Program Manager to oversee inpatient audits, DRG coding validation, and quality across internal teams and external vendors. You will ensure timely audits, defensible determinations, and strong SLA adherence while managing offshore and onshore resources.

The role emphasizes leadership in audit accuracy, regulatory compliance, and program enhancements to meet evolving healthcare requirements and Customer care standards.