Payment Integrity Professional

Location: Remote nationwide within the United States; occasional travel to hirify.global offices for training or meetings may be required.

Salary: $65,000–$88,600 per year, plus eligibility for a bonus incentive plan.

Company

hirify.global is a U.S. healthcare company providing insurance and healthcare services for people with Medicare and Medicaid, families, individuals, military personnel, and communities.

What you will do

• Research claims, coding guidelines, and data anomalies to support accurate payment and reduce costs.
• Identify and validate code-edit opportunities using Medicare, Medicaid, and industry coding standards.
• Determine appropriate courses of action independently, including in ambiguous situations.
• Build relationships with Code Edit Management, internal stakeholders, and external code-editing vendors.
• Present findings to large audiences and drive process improvements.

Requirements

• Certified Professional Coder certification from AHIMA or AAPC.
• At least 2 years of experience using coding guidelines and submitting, reading, or interpreting claims.
• Expert knowledge of CPT, HCPCS, and ICD code sets.
• Strong understanding of CMS guidelines, state Medicaid guidelines, correct-coding initiatives, national benchmarks, and industry standards.
• Analytical thinking, strong attention to detail, independent judgment, and presentation skills.
• Must work remotely from within the United States and maintain a dedicated workspace that protects member PHI and HIPAA information.

Nice to have

• Experience with code-editing vendor tools.
• Experience leading projects or processes.
• Knowledge of Microsoft Access, hirify.global systems, and hirify.global code-editing processes.
• Experience in a fast-paced, metric-driven operational setting.

Culture & Benefits

• Remote work at home during typical Monday–Friday business hours, 8 hours per day.
• 40 scheduled hours per week.
• Medical, dental, and vision benefits.
• 401(k), paid time off, company and personal holidays, and paid parental and caregiver leave.
• Short- and long-term disability, life insurance, home-office telephone equipment, and other wellness benefits.
• Home internet service must provide at least 25 Mbps download and 10 Mbps upload speeds.

Hiring process

• Selected applicants may complete a pre-recorded voice interview or SMS text interview through HireVue.
• Voice interviews typically take 10–15 minutes; SMS interviews typically take 5–10 minutes.
• Applicants who advance will proceed to subsequent interview rounds.