Senior Manager, Payment Integrity & Program Optimization

Devoted Health

United States

Remote

USD 111,000 - 150,000

Full time

3 days ago

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Benefits offered by this job

Health plan

Generous paid time off

$100 monthly mobile or internet

Stock options

Bonus eligibility for all roles

Parental leave

401K program

Job summary

Devoted Health is seeking a senior program development leader to advance payment integrity initiatives across edits, audits, and cross-functional execution. You will drive portfolio performance, collaborate with Engineering, Data Science, and Operations to implement scalable solutions, and own end-to-end program delivery, including validation, maintenance, and compliance.

You will mentor teams, translate complex data into actionable insights, and influence stakeholders to improve provider

Qualifications

Bachelor's degree and at least 6 years in health plan, vendor, or related setting.
Strong expertise in healthcare claims, payment integrity, and reimbursement operations.
Ability to investigate complex claims and translate insights into solutions.

Responsibilities

Program Operations & Portfolio Management: Manage internal and vendor-supported payment integrity programs across implementation, monitoring, maintenance, and ongoing operational support.
Portfolio Assurance & Optimization: Evaluate program performance, including savings, hit rates, yield, turnaround times, and provider impacts.
Complex Root Cause Analysis & Remediation: Independently investigate complex claims, configuration, and operational issues. Determine root causes and impact, develop evidence-based recommendations, and drive resolution across functions.
Concept Implementation & Validation: Partner with clinical, coding, and reimbursement SMEs to translate concept logic into clear implementation requirements. Collaborate with Engineering, Product, Data Science, and operational teams to support configuration, testing, deployment, and troubleshooting.
Maintenance, Monitoring & Compliance: Coordinate portfolio maintenance, backsweeps, performance monitoring, regulatory updates, and compliance-related activities. Ensure appropriate controls, documentation, escalation, and follow-through.
Program & Process Improvement: Identify recurring inefficiencies, capacity constraints, and operational risks. Partner with department leadership to evaluate and implement improvements involving workflows, resource allocation, automation, and technology.
Data-Driven Decision-Making: Use claims information, operational metrics, analytical tools, and performance trends to investigate issues, evaluate opportunities, and inform recommendations.
Cross-Functional Leadership & Influence: Develop a clear point of view, constructively challenge assumptions, and bring together stakeholders across Payment Integrity, Claims, Compliance, Engineering, Product, and Data Science to achieve measurable outcomes.
Project Management & Operational Scalability: Independently lead complex, multi-phase initiatives, manage competing priorities and dependencies, and strengthen repeatable processes, knowledge sharing, and cross-coverage.