Senior Manager, Payment Integrity & Provider Escalations

Devoted Health; United States; À distance; USD 111 000 - 150 000; Plein temps

Avantages offerts par ce poste

Health, dental and vision

Paid time off

Stipend for mobile or internet

Stock options

Bonus eligibility

Parental leave

401K program

Résumé du poste

Devoted Health is seeking a Senior Manager of Payment Integrity to lead the PI disputes and appeals delivery teams, drive SLA compliance, and ensure audit readiness. You will leverage CMS regulations and coding knowledge to guide complex claims reviews and educate providers across cross-functional partners.

The role emphasizes operational leadership, data analytics, and process modernization with potential AI-enabled improvements, while coordinating with senior leadership on performance metrics.

Qualifications

• 5+ years in healthcare PI and provider dispute management.
• 3+ years supervisory/people management experience.
• Deep CMS & coding expertise across CPT/HCPCS/ICD-10/NCCI/NCD/LCD guidelines.

Responsabilités

• Direct and mentor the PI disputes and appeals delivery team and manage SLA adherence.
• Serve as SME on CMS regulations and billing guidelines.
• Perform root-cause trend analyses on disputes and identify system or policy gaps.
• Translate insights into actionable recommendations for upstream PI teams and provider education.
• Represent dispute performance to senior leadership with clear reporting and escalations.
• Maintain audit-ready documentation and governance for CMS audits and internal reviews.
• Collaborate across clinical, coding, and operations to educate providers.

Connaissances

Healthcare PI

Team Leadership

CMS Regulations

CPT/HCPCS Coding

Data Analytics

Cross-functional

Formation

AAPC/AHIMA Medical Coding Certification

Outils

SQL

Tableau/Power BI

Cotiviti/Optum/ChangeHC

Description du poste

Devoted Health is seeking a Senior Manager of Payment Integrity to lead the PI disputes and appeals delivery teams, drive SLA compliance, and ensure audit readiness. You will leverage CMS regulations and coding knowledge to guide complex claims reviews and educate providers across cross-functional partners.

The role emphasizes operational leadership, data analytics, and process modernization with potential AI-enabled improvements, while coordinating with senior leadership on performance metrics.