Strategic Payment Integrity Manager

Corewell Health; United States; Remote; USD 95,000 - 145,000; Full time

Benefits offered by this job

On-demand pay program

Discounts directory

Identity theft protection

Retirement options with match

Job summary

Corewell Health seeks a Payment Integrity Manager to oversee all aspects of the program, leading staff and coordinating with Medical Policy and Provider Relations to achieve cost containment in medical claims payments.

The role requires expertise in healthcare payment methodologies, regulatory compliance, and audit execution, with strong leadership and collaboration across departments.

Qualifications

• Bachelor’s degree or equivalent in Healthcare, Nursing, or Business.
• 5 years for healthcare claim auditing or equivalent in auditing, medical coding, revenue cycle, or regulatory areas.
• Deep understanding of provider payment methodologies (DRGs, capitation, RBRVS, APC, percent of charges).
• Familiarity with state and federal healthcare billing and coding regulations.
• Experience with government programs (Medicare, Medicaid, FEHB) preferred.

Responsibilities

• Develops an annual risk assessment and audit plan for Payment Integrity strategy.
• Manage staff and coordinate audits of medical claims for proper billing and payments.
• Summarize findings and coordinate provider communication and fund recovery.
• Collaborate with Medical, Pharmacy, and Provider teams on policy alignment for cost containment.
• Establish processes for case assignment and Provider appeals response.

Skills

Healthcare auditing

Staff management

Regulatory compliance

Provider payment methods

Cost containment

Education

Bachelor’s degree in Healthcare, Nursing, or Business

Tools

RHIT

RHIA

CCS

CCS-P

CPC-P

CPC-H

Job description

Corewell Health seeks a Payment Integrity Manager to oversee all aspects of the program, leading staff and coordinating with Medical Policy and Provider Relations to achieve cost containment in medical claims payments.

The role requires expertise in healthcare payment methodologies, regulatory compliance, and audit execution, with strong leadership and collaboration across departments.