Remote Inpatient Payment Integrity Lead

Devoted; United States; Teletrabalho; USD 73 000 - 125 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Health, Dental & Vision

Generous PTO

Stock options

Bonus eligibility

401K program

Resumo da oferta

Devoted Health is seeking a Payment Integrity Inpatient Program Manager to oversee inpatient audit programs, including clinical validation, DRG coding validation, readmission reviews, and vendor coordination. You will ensure audit accuracy, timeliness, and defensibility across internal teams and external partners.

You will lead training, quality monitoring, and escalation processes, while driving continuous improvement and adherence to regulatory standards in a fast-paced healthcare environment.

Qualificações

• 2-3 years healthcare audit or related experience.
• Strong clinical and inpatient coding knowledge; CCS/RHIA/RHIT/RN or equivalent inpatient coding/clinical validation experience required.
• Inpatient DRG coding and validation experience strongly preferred.
• Experience with ICD-10-CM coding and readmission logic.
• Experience reviewing medical records for audit accuracy and compliance.
• Ability to interpret clinical documentation to support audit decisions.
• Experience collaborating across clinical, coding, audit, and operations teams.
• Strong analytical skills to assess audit trends and root causes.
• Proven experience training payment integrity audits.

Responsabilidades

• Perform complex inpatient Payment Integrity audits, including clinical validation, DRG coding validation, readmission, and hospital bill audit reviews, with clear, defensible audit rationale.
• Provide guidance to internal staff and external vendors, managing calibration sessions, feedback loops, education, and ongoing quality monitoring.
• Develop and maintain program-specific training materials, audit guidance, review standards, and supporting documentation.
• Perform quality reviews and trend analysis to ensure coding, clinical, and audit findings are accurate and compliant.
• Monitor program metrics, dispute trends, and vendor results, driving root-cause analysis and continuous improvement.
• Collaborate with stakeholders to resolve complex audit, coding, and escalation issues as SME.
• Support dispute and appeals management activities, including escalation and corrective action planning.
• Support new audit concepts and methodologies aligned with regulatory needs.

Conhecimentos

Healthcare audit

Coding review

Clinical documentation

Inpatient coding

Regulatory compliance

Audit quality

Vendor management

Leadership

Formação académica

Bachelor’s Degree

CCS/RHIA/RHIT

Descrição da oferta de emprego

Devoted Health is seeking a Payment Integrity Inpatient Program Manager to oversee inpatient audit programs, including clinical validation, DRG coding validation, readmission reviews, and vendor coordination. You will ensure audit accuracy, timeliness, and defensibility across internal teams and external partners.

You will lead training, quality monitoring, and escalation processes, while driving continuous improvement and adherence to regulatory standards in a fast-paced healthcare environment.