Senior Payment Integrity Architect — Remote, Cross-Setting

Devoted; Northern (KY); Hybrid; USD 111,000 - 150,000; Full time

Benefits offered by this job

Health, dental, vision plan

Generous paid time off

$100 monthly mobile stipend

Stock options

Bonus eligibility

Parental leave

401K

Job summary

Devoted Health is seeking a Senior Payment Integrity Program Development Manager to lead the clinical logic behind our claim edit and audit pipeline. You will translate guidelines, analyze inpatient and ambulatory data, and design automated logic to detect and prevent improper payments.

As an autonomous senior contributor, you will own end-to-end concept development from discovery to testing, collaborate with Clinical Operations, SIU, Claims and Legal, and present findings to executives to drive

Qualifications

• Active RN license with inpatient experience (ICU/Med-Surg).
• Active coding certification (CPC/CCS/CCS-P/RHIA).
• 5+ years creating net-new claim edits in health plans or vendor settings.

Responsibilities

• Ideate greenfield payment integrity concepts by researching guidelines and billing trends.
• Architect end-to-end logic mapping clinical docs to edits.
• Validate hypotheses with data analysis across clinical settings.
• Lead cross-functional policy development with executives and stakeholders.
• Own concept rollout from discovery through testing and post-launch tuning.

Skills

RN license

Coding certification

Net-new edit authoring

Medicare regulations

Multi-setting billing

Logic writing

Data analysis

Executive influencing

Tools

Optum/CES

Cotiviti

McKesson

Job description

Devoted Health is seeking a Senior Payment Integrity Program Development Manager to lead the clinical logic behind our claim edit and audit pipeline. You will translate guidelines, analyze inpatient and ambulatory data, and design automated logic to detect and prevent improper payments.

As an autonomous senior contributor, you will own end-to-end concept development from discovery to testing, collaborate with Clinical Operations, SIU, Claims and Legal, and present findings to executives to drive