Inpatient Payment Integrity Program Lead

Devoted Health; United States; On-site; USD 73,000 - 125,000; Full time

Benefits offered by this job

Health plan

Dental plan

Vision plan

Paid time off

Stipend for mobile/internet

Stock options

Bonus eligibility

Parental leave

401K

Job summary

Devoted Health seeks a Payment Integrity Inpatient Program Manager to oversee inpatient audit, DRG coding validation, quality reviews, and vendor coordination across internal teams and external partners. You will ensure accurate, timely audit determinations, compliance with regulatory standards, and SLA adherence while reducing backlogs and improving program outcomes.

This role requires strong clinical/coding expertise and proven leadership in training and guiding both staff and offshore

Qualifications

• 2-3 years in healthcare audit, Payment Integrity, coding review, or compliance.
• Strong inpatient coding knowledge; CCS, RHIA, RHIT, RN, or equivalent inpatient coding/clinical validation experience required.
• Inpatient DRG coding and validation experience including ICD-10-CM, principal and secondary diagnoses, MCC/CC, POA indicators, and readmission logic.
• Experience reviewing medical records to ensure audit accuracy, coding/clinical correctness, compliance, and defensibility of determinations.
• Experience operating within structured audit programs with defined criteria, documenting rationale, and ensuring consistency.
• Ability to interpret clinical/coding documentation to support audit decisions and resolve gaps.
• Experience collaborating across clinical, coding, audit, and operational teams in a complex healthcare environment.
• Strong analytical skills to assess audit trends, root causes, and documentation gaps.
• Strong organizational discipline to manage multiple responsibilities.
• Proven experience in training payment integrity audits.

Responsibilities

• Perform inpatient Payment Integrity audits with defensible rationale.
• Provide oversight to internal staff and external vendors, managing calibration sessions and quality monitoring.
• Develop and maintain training materials, audit guidance, and review standards.
• Perform quality reviews and trend analyses to ensure accuracy and defensibility.
• Monitor program metrics and vendor results, identifying root causes and driving improvements.
• Collaborate with stakeholders to resolve audit, coding, clinical, and escalation issues as the SME.
• Support dispute and appeals management including escalation review and corrective action planning.
• Support the implementation of new audit concepts and methodologies.

Skills

Healthcare audit

Payment Integrity

Coding review

Clinical documentation review

Compliance

Audit quality

Leadership

Vendor management

Training

Data analysis

Education

Bachelor's Degree

Job description

Devoted Health seeks a Payment Integrity Inpatient Program Manager to oversee inpatient audit, DRG coding validation, quality reviews, and vendor coordination across internal teams and external partners. You will ensure accurate, timely audit determinations, compliance with regulatory standards, and SLA adherence while reducing backlogs and improving program outcomes.

This role requires strong clinical/coding expertise and proven leadership in training and guiding both staff and offshore