Manager, Payment Integrity Auditing (Healthcare)

Location: Remote/telecommuter from one of the listed U.S. states: Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Idaho, Iowa, Kansas, Kentucky, Maine, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington, or Wisconsin.

Salary: $118,900–$202,100 national range; $135,600–$230,500 national-plus range for higher-cost markets including Western Washington and Alaska.

Company

hirify.global works to improve healthcare outcomes and customer experiences through health insurance and healthcare services.

What you will do

• Manage clinical coding and payment integrity auditors, including hiring, coaching, performance management, and professional development.
• Oversee payment integrity audit programs covering DRG validation, itemized bill reviews, level-of-care reviews, hospital readmission audits, and other pre-payment and post-payment initiatives.
• Set project priorities, define audit scope, and optimize payment integrity processes and systems.
• Provide guidance on complex claims and payment integrity issues while ensuring timely execution of audit activities.
• Monitor internal and vendor audit performance, identify payment and billing trends, and use data-driven insights to improve payment accuracy.
• Communicate program strategy and align payment integrity activities with organizational, contractual, regulatory, and compliance requirements.

Requirements

• Bachelor’s degree or 8 years of relevant work experience.
• At least 5 years of analytical experience in a technical, healthcare, or business-related discipline, including 3 years leading medium- to large-size payment integrity projects.
• Certified Professional Coder designation or 6 years of payment integrity experience.
• Strong analytical, problem-solving, written communication, presentation, and relationship-building skills.
• Must be eligible to work from one of the listed U.S. states.

Nice to have

• Experience with healthcare claims processing, provider billing, or revenue cycle management systems.
• Hospital bill auditing experience, including DRG validation or itemized bill review.
• Registered Nurse license.
• Experience with appeals, data mining, pre-payment editing, subrogation, COB, and FWA/SIU.
• Advanced Microsoft Office Suite skills.

Culture & Benefits

• Remote work from home with a telecommuter classification.
• Medical, vision, dental, life, and disability insurance options.
• 401(k) employer match and a pension plan vested after three years.
• Paid time off, wellness resources, counseling, and stress-management programs.
• Tuition assistance for undergraduate and graduate education.
• Employee recognition programs and professional development opportunities.