Devoted Studios
Payment Integrity Program Development Manager
Remote USA · Full-time
Sponsorship not specified$73k-$120kDetected 29 days ago
SQLData AnalysisLLMsA/B TestingCompliancePatient CareProblem SolvingClaims Management
About the role
- Our Payment Integrity Concept Development Department is at the forefront of this effort, ensuring provider claims are paid correctly, free of errors, and aligned with contractual terms.
- As our Payment Integrity Program Development Manager you will serve as a premier coding and billing regulations expert operating in a high-autonomy, outcomes-driven Individual Contributor (IC) role.
- You will bridge coding and billing expertise, regulatory policy, and data analytics to transform complex guidelines into intelligent, automated payment integrity software logic.
Responsibilities
- Design payment policies where CMS guidance needs to be supplemented to ensure defensibility in supporting the concept.
- Proactively anticipate downstream appeal behaviors and provider disputes to craft strong explanatory narratives within the rule design.
- Proactively identify pipeline obstacles, problem-solve execution blocks, and implement logic adjustments to drive greater efficiency.
- Partner with PI Directors, internal auditors, SIU, and claims operations to ensure coding and billing appropriateness, regulatory compliance, and cross-functional strategic alignment.
- We give our managers creative liberty to design innovative concepts across the entire spectrum of prospective pre- and post-payment edits and audits.
- Manage the full lifecycle of edit and audit development - from initial coding and billing hypothesis to detailed rule design.
Requirements
- Proven subject matter expertise as a coding and billing regulations expert, with deep familiarity interpreting CMS policies (LCDs, NCDs, LCAs), NCCI bundling edits, and provider manuals.
- Demonstrated experience and comfort with concept development logic, including a proven track record of writing logic rules or structural guidelines for claims processing implementation.
- Demonstrated ability to plan, organize, and coordinate individual concepts and initiatives, utilizing strong problem-solving skills to clear operational obstacles and meet deadlines.
- Advanced experience with institutional/facility billing rules (MS-DRG, APR-DRG, APC/OPPS, revenue codes) and facility packaging workflows.
Compensation
- $73,000-$120.000 / year
- The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting.
- Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package.
- Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.
Benefits
- Additional national credentials such as Certified Coding Specialist (CCS), Certified Coding Specialist - Physician-based (CCS-P), or Registered Health Information Administrator (RHIA).
- Employer sponsored health, dental and vision plan with low or no premium
- Generous paid time off
- $100 monthly mobile or internet stipend
- Stock options for all employees
- Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles
- Parental leave program
- Our Total Rewards package includes:
- Our total rewards package is for full time employees only.
Company info
- At Devoted, our mission is to build trust with our providers and members by ensuring claims are paid accurately and on time with transparent policies.
Equal opportunity
- Devoted is an equal opportunity employer.
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