RN, Payment Integrity Manager

Pivotal Placement Services, Inc; Frisco (TX); Remote; USD 110,000 - 140,000; Full time

Benefits offered by this job

Fully remote

Leadership role

Strategy impact

Job summary

Pivotal Placement Services, Inc is seeking a Payment Integrity Manager, an RN with coding expertise, to lead payment integrity and reimbursement performance. You will collaborate with clinical, coding, and operational teams to ensure payments are accurate and compliant.

You will oversee audits, identify revenue recovery opportunities, and mentor staff while driving continuous improvement across the organization. This is a fully remote role across the United States.

Qualifications

• Active RN license in the state of employment.
• Current coding certification (CPC, CCS, RHIT, or equivalent).
• Experience leading payment/revenue integrity initiatives is preferred.

Responsibilities

• Lead payment integrity and revenue integrity initiatives across the organization.
• Oversee audits and reviews focused on coding accuracy, reimbursement, and compliance.
• Identify trends, recover revenue opportunities, and reduce payment inaccuracies.
• Collaborate with clinical, coding, and operational stakeholders to improve processes and outcomes.
• Analyze claims, coding practices, and reimbursement methodologies to identify areas for improvement.
• Mentor and support team members while helping build a culture of continuous improvement.

Skills

Payment integrity

Revenue integrity

Medical billing & coding

Auditing & compliance

Clinical healthcare experience

Leadership

Education

Active RN license

Coding certification (CPC/CCS/RHIT or equivalent)

Job description

Fully remote, open to candidates located anywhere in the United States.

Make a Meaningful Impact on Healthcare Quality, Compliance, and Financial Integrity

Are you an experienced RN passionate about identifying opportunities to improve healthcare outcomes, coding accuracy, and payment integrity? We're seeking a Payment Integrity Manager who will play a critical leadership role in ensuring claims accuracy, driving reimbursement integrity, and helping create a more efficient healthcare system.

In this role, you'll partner with clinical, coding, and operational teams to ensure payments are accurate, compliant, and aligned with industry standards. Your work will directly influence organizational performance while helping ensure healthcare resources are utilized appropriately and effectively.

What You'll Do

• Lead payment integrity and revenue integrity initiatives across the organization.
• Oversee audits and reviews focused on coding accuracy, reimbursement, and compliance.
• Identify trends, recover revenue opportunities, and reduce payment inaccuracies.
• Collaborate with clinical, coding, and operational stakeholders to improve processes and outcomes.
• Analyze claims, coding practices, and reimbursement methodologies to identify areas for improvement.
• Mentor and support team members while helping build a culture of continuous improvement.

What Makes You a Great Fit

• Active RN license in your state of employment
• Current coding certification (CPC, CCS, RHIT, or equivalent)

Experience in:

• Payment Integrity
• Revenue Integrity
• Medical Billing & Coding
• Auditing & Compliance
• Clinical healthcare experience
• At least 1 year of leadership or supervisory experience

Preferred Experience

• DRG validation or review experience
• Health plan, payer, managed care, or revenue cycle experience
• Strong analytical and problem-solving skills

Why Join Us?

• Fully remote opportunity
• High-visibility leadership role
• Opportunity to influence organizational strategy and financial performance
• Collaborative team environment focused on continuous improvement and innovation