Manager, Payment Integrity Innovation & Audit Strategy

Sagility; United States; On-site; USD 140,000 - 200,000; Full time

Job summary

Sagility seeks a Manager, Payment Integrity Program Development & Innovation to lead a team of experts in building and optimizing audit programs that identify and recover healthcare overpayments across inpatient, outpatient, professional, and DME claim types.

The role partners with analytics, operations, and client services to maximize recovery opportunities, ensure program effectiveness, and expand audit capabilities in a data-driven healthcare environment.

Qualifications

• Bachelor’s degree in Nursing, Health Information Management, Healthcare Administration, Business Administration, Finance, or a related field.
• Minimum of 5 years of healthcare Payment Integrity experience.
• Minimum of 3 years of leadership experience managing audit, coding, clinical, payment integrity, or SME teams.

Responsibilities

• Lead, mentor, and develop a team of Subject Matter Experts responsible for complex audit program design and implementation.
• Develop and maintain a portfolio of complex payment integrity audit concepts and recovery initiatives.
• Collaborate with internal stakeholders to prioritize and implement new audit programs.
• Define business requirements and selection criteria for complex audit programs.
• Monitor audit performance and refine targeting strategies to improve recovery yield and audit accuracy.
• Provide SME input across regulatory, clinical, and client-facing activities.

Skills

Payment Integrity Program Management

Complex Audit Concept Development

Claims Analytics and Audit Selection

Regulatory Compliance Knowledge

Leadership and Team Development

Strategic Planning

Project and Portfolio Management

Written and Verbal Communication

Client Relationship Management

Process Improvement

Education

Bachelor’s degree in Nursing, Health Information Management, Healthcare Administration, Business Administration, Finance, or related field

Job description

Sagility seeks a Manager, Payment Integrity Program Development & Innovation to lead a team of experts in building and optimizing audit programs that identify and recover healthcare overpayments across inpatient, outpatient, professional, and DME claim types.

The role partners with analytics, operations, and client services to maximize recovery opportunities, ensure program effectiveness, and expand audit capabilities in a data-driven healthcare environment.