Senior Manager, Payment Integrity & Provider Escalations

devoted; United States; On-site; USD 180,000 - 230,000; Full time

Job summary

Devoted is seeking a Senior Manager of Payment Integrity to oversee disputes and appeals delivery teams, directing end-to-end operations and SLA adherence across all claim reviews.

You will partner with leadership, drive data-driven analyses of CPT/HCPCS codes and CMS guidelines, and translate findings into actionable provider education and policy enhancements. This role emphasizes cross-functional collaboration, audit readiness, and innovative use of AI and automation to improve throughput.

Qualifications

• 5+ years in Healthcare PI and dispute management.
• 3+ years of supervisory or people management experience.
• Deep CMS & coding knowledge: CPT, HCPCS, ICD-10, NCCI, NCD/LCD guidelines.
• Strong analytical skills for root-cause analysis of disputes.
• Ability to translate findings into provider-facing guidance.

Responsibilities

• Operational & SLA Management: oversee PI disputes and appeals delivery team and ensure SLA compliance.
• Serve as SME on CMS regulations and billing guidelines.
• Perform trend analyses on dispute data and CPT/HCPCS to identify root causes.
• Translate insights into actionable recommendations to upstream teams.
• Represent performance to senior leadership with clear reporting.
• Maintain documentation and audit readiness for CMS/state audits.
• Collaborate across clinical, coding and operational teams to educate providers.
• Identify opportunities to leverage AI tools to improve throughput.

Skills

Healthcare PI

Leadership

CMS Regulations

Coding Expertise

Data Analytics

Communication

Education

Medical coding certification

Tools

SQL

Tableau

Power BI

Cotiviti

Optum

Change Healthcare

Job description

Devoted is seeking a Senior Manager of Payment Integrity to oversee disputes and appeals delivery teams, directing end-to-end operations and SLA adherence across all claim reviews.

You will partner with leadership, drive data-driven analyses of CPT/HCPCS codes and CMS guidelines, and translate findings into actionable provider education and policy enhancements. This role emphasizes cross-functional collaboration, audit readiness, and innovative use of AI and automation to improve throughput.