Payment Integrity Lead: Disputes & Provider Escalations

Devoted Health Services, Inc; Waltham (MA); On-site; USD 111,000 - 150,000; Full time

Benefits offered by this job

Health benefits

Paid time off

Monthly mobile stipend

Stock options

Bonus eligibility

401K

Parental leave

Job summary

Devoted Health seeks a Senior Manager of Payment Integrity to lead the disputes and appeals delivery teams. You will own end-to-end operations, including queue management, SLA adherence, QA, and training, while ensuring compliance with CMS rules and internal standards.

You will partner with clinical, coding, and leadership teams to translate findings into provider guidance and policy improvements, leveraging AI-enabled workflows for efficiency.

Qualifications

• 5+ Years of Healthcare PI & Dispute Experience in healthcare payment integrity or dispute operations.
• 3+ Years of supervisory or people management experience.
• Deep CMS regulations mastery and CPT/HCPCS/ICD-10/NCCI/NCD/LCD knowledge.
• Strong ability to analyze claims data and drive upstream process improvements.

Responsibilities

• Direct and oversee the Payment Integrity disputes and appeals delivery team, ensuring SLA adherence and quality.
• Serve as SME on CMS guidelines and complex billing policies; advise delivery teams and cross-functional partners.
• Perform granular trend analyses on dispute data to identify root causes and volume spikes.
• Translate insights into actionable recommendations for edit and audit teams to reduce overturns.
• Represent dispute performance to senior leadership with clear reporting and escalation handling.
• Maintain rigorous documentation and audit readiness for CMS program audits and regulatory reviews.
• Collaborate to develop provider education materials and external billing guidance.

Skills

CMS & Coding Expertise

People Management

Root-Cause Analytics

Data-Driven Research

Cross-Functional Collaboration

AI / LLM Proficiency

Active medical coding certification

Billing & Claims Knowledge

Tools

SQL

Tableau

Power BI

Claim Editing Engines

Job description

Devoted Health seeks a Senior Manager of Payment Integrity to lead the disputes and appeals delivery teams. You will own end-to-end operations, including queue management, SLA adherence, QA, and training, while ensuring compliance with CMS rules and internal standards.

You will partner with clinical, coding, and leadership teams to translate findings into provider guidance and policy improvements, leveraging AI-enabled workflows for efficiency.