Payment Integrity Program Manager

Jobgether SRL; United States; On-site; USD 73,000 - 120,000; Full time

Benefits offered by this job

Health coverage

401(k) retirement plan

Generous PTO

Remote work

Job summary

Jobgether SRL on behalf of a partner seeks a Payment Integrity Program Manager based in the United States. The role is fully remote and leads inpatient audit programs spanning clinical validation, DRG coding, readmission reviews, and hospital bill audits with defensible determinations.

You will collaborate with internal teams, offshore staff, and external vendors to maintain standards, train staff, and monitor trends for performance and regulatory alignment.

Qualifications

• 2-3 years of experience in healthcare auditing, Payment Integrity, coding review, clinical documentation review, or healthcare compliance.
• Strong inpatient coding expertise with CCS/RHIA/RHIT/RN or equivalent.
• Experience with inpatient DRG assignment and validation, ICD-10-CM coding and readmission logic.
• Experience reviewing medical records for audit accuracy and defensibility.
• Ability to interpret clinical documentation and identify gaps to support audit decisions.

Responsibilities

• Perform complex inpatient Payment Integrity audits with documented, defensible rationale.
• Provide oversight to onshore and offshore teams and external vendors with calibration and quality monitoring.
• Develop program-specific training materials, audit guidance, and review standards.
• Conduct quality reviews and trend analyses to verify findings and ensure regulatory alignment.
• Monitor metrics, disputes, turnaround times, and vendor performance for continuous improvement.
• Serve as SME across clinical, coding, audit, and operations teams to resolve escalations.
• Support dispute and appeals activities including audit rationale assessments and corrective actions.
• Contribute to implementing new audit concepts and methodologies as requirements evolve.

Skills

Healthcare auditing

Payment Integrity

Coding review

Clinical documentation review

Leadership

Training others

Analytical skills

Communication

Education

Bachelor's degree preferred

Job description

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Payment Integrity Program Manager based in United States.

This role oversees inpatient Payment Integrity programs spanning audit, appeals, quality, and review operations.

You will ensure audit determinations are accurate, timely, clinically sound, and defensible.

The position combines hands-on clinical and coding expertise with program oversight and operational leadership.

You will collaborate with internal teams, offshore staff, and external vendors to maintain consistent standards.

The role also uses quality analysis, trend monitoring, and root-cause assessment to improve program performance.

As a subject matter expert, you will help resolve complex cases and support evolving audit methodologies and regulatory requirements.

This is a fully remote opportunity with broad influence across payment integrity operations and quality outcomes.

Accountabilities

• Perform complex and escalated inpatient Payment Integrity audits, including clinical validation, DRG coding validation, readmission reviews, and hospital bill audits, while documenting clear and defensible rationale for determinations.

• Provide oversight and guidance to stateside and offshore teams and external vendors through calibration sessions, feedback, education, and ongoing quality monitoring.

• Develop and maintain program-specific training materials, audit guidance, review standards, and supporting documentation.

• Conduct quality reviews and trend analysis to verify coding, clinical, and audit findings and ensure alignment with regulatory, contractual, and organizational requirements.

• Monitor program metrics, dispute trends, turnaround performance, and vendor results, identifying root causes and recommending corrective actions and continuous improvements.

• Serve as a subject matter expert for assigned programs, partnering with clinical, coding, audit, operational, and leadership teams to resolve complex issues and escalations.

• Support dispute and appeals activities, including escalation reviews, audit-rationale assessments, and corrective-action planning.

• Contribute to the implementation of new audit concepts, review methodologies, and program enhancements as business and regulatory requirements evolve.

Requirements

• 2--3 years of experience in healthcare auditing, Payment Integrity, coding review, clinical documentation review, or healthcare compliance.

• Strong clinical and inpatient coding expertise, with CCS, RHIA, RHIT, RN, or equivalent inpatient coding or clinical-validation experience required.

• Demonstrated expertise in inpatient DRG assignment and validation, including ICD-10-CM coding, principal and secondary diagnoses, MCC/CC identification, POA indicators, clinical documentation review, severity of illness, risk of mortality, and readmission logic.

• Experience reviewing medical records to assess audit accuracy, coding and clinical correctness, compliance, and defensibility.

• Experience working within structured audit programs, applying defined criteria, documenting rationale, and maintaining consistency across audit outcomes.

• Ability to interpret clinical and coding documentation, identify documentation gaps or discrepancies, and use evidence to support audit decisions.

• Experience collaborating across clinical, coding, audit, and operational functions within complex healthcare environments.

• Strong analytical and problem-solving skills, including the ability to identify audit trends, root causes, and documentation gaps affecting quality and performance.

• Proven experience training others on Payment Integrity auditing practices.

• Strong organizational and operational discipline, with the ability to manage multiple priorities and meet deadlines.

• Bachelor's degree preferred.

• Strong leadership, communication, and interpersonal skills for working with internal and external stakeholders.

• Experience managing offshore vendors is preferred.

• Familiarity with AI tools, automation, or LLM-based workflows in operational environments is a plus.

Benefits

• Annual salary range of $73,000--$120,000, with the final offer based on experience, qualifications, certifications, education, skills, and work location.

• Employer-sponsored health, dental, and vision coverage with low or no employee premiums.

• Generous paid time off.

• $100 monthly mobile or internet stipend.

• Stock options for eligible employees.

• Bonus eligibility for applicable roles.

• Parental leave program.

• 401(k) retirement program.

• Additional benefits and total rewards for eligible full-time employees.

• Fully remote work environment.

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