Remote Payment Integrity Program Manager - Inpatient Audit

Jobgether SRL; United States; Remote; 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

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.