Senior Payment Integrity Manager, Devoted Health

• Bachelor's degree and a minimum of 6 years of relevant experience
• Understanding of US healthcare
• Understanding of claims adjudication, revenue cycle management, and payment integrity
• Ability to collaborate, communicate, and influence horizontally and vertically
• Being comfortable in both leadership and execution roles
• Being comfortable with ambiguity and startup environment
• Ability to incorporate company vision, mission, and values in decision making

Desirable

• The Senior Manager, Payment Integrity is a senior operational leader responsible for overseeing the strategy, execution, and performance optimization of the organization's payment integrity programs
• This role ensures that both prepayment and post payment audit functions are designed and delivered to achieve savings, reduce error rates, and align with regulatory requirements
• The Senior Manager drives operational excellence, manages escalations, collaborates cross-functionally to improve end-to-end audit workflows, and provides guidance to internal teams and external partners
• Our Payment Integrity Department ensures that provider claims are paid correctly by the responsible party, for eligible members, according to contractual terms, not in error or duplicate, and free of wasteful or abusive practices
• You'll lead and optimize the execution of enterprise payment integrity initiatives, with accountability for performance across prepay and postpay claims review programs
• Translate organizational strategy into operational action plans, ensuring alignment with savings goals, audit integrity, and regulatory compliance
• Partner with analytics, finance, compliance, and tech to identify new audit opportunities, improve processes, and develop scalable solutions
• Oversee the health of audit pipelines by ensuring work inflow and outflow are properly forecasted, balanced, and executed
• Monitor program KPIs such as savings, throughput, adjustment timeliness, and audit yield. Take corrective action when performance falls short
• Use data to identify root causes of inefficiencies or payment errors and lead the development of solutions to reduce future risk
• Serve as a senior escalation point for complex issues involving claims adjustments, provider disputes, and operational bottlenecks
• Collaborate with departments such as Claims, Appeals, Provider Relations, and Medical Management to troubleshoot issues and implement improvements across the payment life cycle