Senior Manager, Payment Integrity and Provider Escalation

Location: Remote USA

Salary: $110,500–$150,000 per year

Company

hirify.global is a healthcare company founded in 2017 that combines data, AI, clinical expertise, and service experiences to improve the health and well-being of older Americans.

What you will do

• Lead and mentor Payment Integrity disputes and appeals delivery teams, managing queues, turnaround times, quality assurance, and SLA compliance.
• Serve as the subject matter expert for complex billing guidelines, reimbursement policies, CMS regulations, and high-complexity claims.
• Analyze dispute trends across CPT/HCPCS codes, modifiers, billing taxonomies, facilities, and regions to identify errors and root causes.
• Translate dispute findings into recommendations for payment integrity edits, audits, policy clarification, provider guidance, and education.
• Report operational performance and trends to senior leadership and resolve high-priority provider escalations.
• Maintain documentation, SOPs, and quality-control frameworks for CMS, state regulatory, and internal audits while identifying AI, automation, and LLM workflow opportunities.

Requirements

• 5+ years of healthcare payment integrity, provider dispute management, coding or clinical documentation review, or claims audit experience.
• 3+ years of supervisory or people-management experience.
• Expert knowledge of CMS regulations, Medicare Advantage disputes, organization determinations, CPT, HCPCS, ICD-10, UB-04, NCCI edits, and NCD/LCD guidelines.
• Experience managing operational metrics, queue throughput, team performance, complex medical-record reviews, and coding or clinical determinations.
• Strong analytical, cross-functional collaboration, and executive communication skills.
• Must be able to work remotely from the United States.

Nice to have

• Active AAPC or AHIMA medical coding certification, such as CPC, CIC, COC, RHIA, or RHIT.
• Experience with LLMs, AI-driven claims intake tools, RPA, healthcare data tools, SQL, Tableau, Power BI, or claims editing engines.
• Provider Relations or Network Management experience and the ability to create provider-facing billing guidance.
• Experience resolving complex, high-dollar, or executive-level provider escalations.

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 and bonus eligibility for roles below Director level.
• 401(k) program and a collaborative, supportive work environment.