Payment Integrity Product Development Specialist (Medtech)

TL;DR

Payment Integrity Product Development Specialist (Medtech): Designing and launching a SNF Payment Integrity audit product by translating clinical and regulatory requirements into scalable audit methodologies and product workflows with an accent on regulatory compliance and operational efficiency. Focus on refining medical necessity criteria, defining MVP scope, and establishing risk-based claim selection logic.

Company

hirify.global is a leading authority in payment integrity solutions dedicated to bringing accuracy, accountability, and clinical excellence to healthcare.

What you will do

• Translate CMS SNF regulations and clinical requirements into audit rules, workflows, and operational processes.
• Validate SNF audit methodologies, including medical necessity criteria and coding requirements.
• Define the MVP scope, product roadmap enhancements, and implementation readiness.
• Develop claim selection logic, risk indicators, and scoring models.
• Design end-to-end workflows for intake, clinical review, provider outreach, and appeals.
• Define operational KPIs and reporting needs for audit outcomes and savings.

Requirements

• 5-10+ years of experience in SNF clinical operations, utilization management, or payment integrity.
• Deep understanding of CMS SNF regulations, PDPM, MDS/RAI, and medical necessity criteria.
• Experience developing or executing clinical audit programs for Medicaid, Medicare, or commercial payors.
• Ability to translate complex regulatory concepts into clear product and operational requirements.
• Strong analytical and data comprehension skills.

Nice to have

• Clinical licensure (RN, PT, OT, SLP).
• Experience with payment integrity vendors or state Medicaid agencies.
• Background in product development or clinical audit solution design.
• Experience developing claims scoring models or working with analytics teams.