Payment Integrity Program Manager (Inpatient)

Location: Remote, United States

Salary: $73,000–$120,000 annually

Company

hirify.global is a healthcare company building an integrated care platform that combines data, AI, clinical, and service experiences to improve the health and well-being of older Americans.

What you will do

• Oversee assigned inpatient Payment Integrity programs covering audits, appeals, quality, and review processes.
• Perform complex clinical validation, DRG coding validation, readmission, and hospital bill audits with clear and defensible determinations.
• Guide internal staff and external vendors through calibration, training, feedback, and quality-monitoring activities.
• Develop program-specific training materials, audit guidance, review standards, and supporting documentation.
• Monitor audit metrics, dispute trends, inventory, SLAs, and vendor performance to identify root causes and prevent backlogs.
• Collaborate with clinical, coding, audit, operational, and leadership stakeholders on escalations, appeals, corrective actions, and program enhancements.

Requirements

• 2–3 years of experience in healthcare audit, Payment Integrity, coding review, clinical documentation review, or compliance.
• Strong inpatient clinical and coding knowledge, including inpatient DRG assignment and validation, ICD-10-CM, principal and secondary diagnoses, MCC/CC identification, POA indicators, and readmission logic.
• CCS, RHIA, RHIT, RN, or equivalent inpatient coding or clinical validation experience.
• Experience reviewing medical records and applying structured audit criteria to produce accurate, consistent, compliant, and defensible outcomes.
• Strong analytical, organizational, communication, and cross-functional collaboration skills.
• Must be able to work remotely from the United States.

Nice to have

• Bachelor’s degree.
• Experience managing offshore vendors.
• Experience with AI tools, automation, or LLM-based workflows in operational settings.

Culture & Benefits

• Employer-sponsored health, dental, and vision plans with low or no premiums.
• Generous paid time off and parental leave.
• $100 monthly mobile or internet stipend.
• Stock options for all employees.
• 401(k) program and bonus eligibility for eligible roles.
• Supportive, diverse, and collaborative work environment.