Senior Manager, Payment Integrity & Provider Escalations

Devoted Health; Oregon; Hybrid; USD 111,000 - 150,000; Full time

Benefits offered by this job

Health, dental & vision benefits

Generous paid time off

$100 monthly mobile stipend

Stock options for all employees

Bonus eligibility for most roles

Parental leave program

401K program

Job summary

Devoted Health is seeking a Senior Manager of Payment Integrity to lead the disputes and appeals delivery team, drive SLA adherence, and partner with cross‑functional teams on CMS guidelines and complex claims.

The role focuses on data‑driven analyses, process modernization with AI tools, and establishing strong audit-ready documentation for CMS programs and regulatory reviews. A strong SME with leadership experience is required.

Qualifications

• 5+ years in healthcare PI and dispute management or related claim auditing.
• 3+ years of supervisory experience leading teams.
• Deep CMS regulations, Medicare Advantage, and coding knowledge (CPT/HCPCS/ICD-10/NCCI).
• Ability to manage operational metrics, queue throughput, and SME activity.

Responsibilities

• Lead the PI disputes and appeals delivery team, overseeing queue health and SLA compliance.
• Serve as SME on billing guidelines, CMS regulations, and high‑complexity claims.
• Perform root-cause analyses on dispute data to identify errors and policy gaps.
• Translate findings into actionable upstream policy and audit improvements.
• Provide leadership reporting and escalate high-priority provider issues to executives.
• Maintain audit-ready documentation and governance for CMS and state reviews.

Skills

Healthcare PI

People management

CMS/Coding

SME leadership

Root-cause analytics

Cross-functional collaboration

Tools

SQL

Tableau

Power BI

Job description

Devoted Health is seeking a Senior Manager of Payment Integrity to lead the disputes and appeals delivery team, drive SLA adherence, and partner with cross‑functional teams on CMS guidelines and complex claims.

The role focuses on data‑driven analyses, process modernization with AI tools, and establishing strong audit-ready documentation for CMS programs and regulatory reviews. A strong SME with leadership experience is required.