Payment Integrity Innovation Lead (Remote)

Sagility India Private Ltd in; El Paso (TX); On-site; USD 110,000 - 170,000; Full time

Job summary

Sagility seeks a Manager, Payment Integrity Program Development & Innovation to lead a team of healthcare payment integrity experts focused on developing, implementing, and optimizing audit programs to identify and recover healthcare overpayments. This role collaborates with clinical, operational, analytics, appeals, and client-facing teams to drive innovative solutions and maximize client value.

The position emphasizes expanding audit capabilities, improving financial outcomes, and delivering

Qualifications

• 5+ years of healthcare Payment Integrity experience.
• 3+ years of leadership experience managing audit, coding, clinical, payment integrity, or SME teams.
• Demonstrated experience developing complex healthcare audit concepts and claim selection methodologies.
• Strong knowledge of healthcare reimbursement methodologies, claims adjudication, coding systems, and payment integrity operations.
• Experience collaborating with analytics, operations, and appeals teams to implement audit programs.

Responsibilities

• Lead, mentor, and develop a team of Subject Matter Experts responsible for complex audit program design and implementation.
• Partner with Operations, Clinical, Appeals, Product, Analytics, Compliance, and Client Services teams to support successful program 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.

Skills

Leadership

Audits & Analytics

Healthcare reimbursement

Team development

Regulatory compliance

Client communication

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 healthcare payment integrity experts focused on developing, implementing, and optimizing audit programs to identify and recover healthcare overpayments. This role collaborates with clinical, operational, analytics, appeals, and client-facing teams to drive innovative solutions and maximize client value.

The position emphasizes expanding audit capabilities, improving financial outcomes, and delivering