Senior Consultant, Payment Integrity (Healthcare)

Location: United States; remote work from anywhere is offered, with location verification during the hiring process.

Company

hirify.global provides an AI and data platform that helps health plans create trusted healthcare data foundations for better payment, care, and operational decisions.

What you will do

• Lead client discovery sessions, workshops, executive presentations, and payment integrity recommendations.
• Act as the internal payment integrity subject matter expert and trusted advisor for payer sponsors and risk panels.
• Research market, industry, and regulatory trends and assess compliance with federal, state, and ERISA regulations.
• Design payment integrity strategies, policies, roadmaps, and external communications aligned with client contracts and goals.
• Configure and validate claim-edit reviews, prior-authorization-to-claim matching, and provider billing-anomaly detection in client data environments.
• Partner with Product, Engineering, Data/Analytics, AI Engineering, and QA teams to improve payment integrity outputs and audit workflows.

Requirements

• 10+ years of experience in healthcare payment integrity, claims auditing, or reimbursement analysis, including 5+ years in consulting or advisory work.
• Deep hands-on knowledge of inpatient/DRG validation, outpatient modifiers, post-acute care, medical necessity, and specialty or high-cost drugs.
• Experience developing, writing, and presenting payment integrity policies, strategies, and roadmaps to executives and payer or provider sponsors.
• Working knowledge of federal, state, and ERISA regulations, fraud, waste, and abuse mitigation, contract compliance, audits, and escalated appeals.
• Experience leading client relationships, discovery sessions, workshops, and executive presentations, with willingness to travel to client sites as needed.
• Comfort working across clinical, operational, data, and technology domains, including cloud data platforms such as Snowflake or Databricks.

Nice to have

• Six Sigma Black Belt, CPC, CCS, CFE, RHIA, or RHIT certification.
• Clinical training or experience in clinical claim editing, post-payment recovery, or Special Investigations.
• Exposure to Agile or lean product development, AI or agent-based automation, and healthcare technology startups.

Culture & Benefits

• Remote-first flexibility with work-from-anywhere support.
• Unlimited paid time off and comprehensive health coverage.
• Equity grants for every employee and eligibility for performance bonuses.
• Home office setup allowance and monthly cell phone allowance.
• Growth-focused, collaborative, and inclusive working environment.

Hiring process

• Interviews are conducted by live video with the camera on; advanced candidates may complete identity and location verification.
• AI-powered tools may support sourcing and interview preparation, while recruiters and hiring teams make progression and hiring decisions.