Payment Integrity Principal (Coding Review)

TL;DR

Payment Integrity Principal (Coding Review): Serve as senior authority for system-level payment integrity strategy, translating coding review domain expertise into scalable rules, workflows, analytics, and AI-driven capabilities. Focus on defining automation strategies, ensuring cohesive platform integration, and partnering with product and engineering to align with future-state vision.

Location: Remote in the US; applicants must already be legally authorized to work in the U.S. (no visa sponsorship or immigration support)

Salary: $125,241 - $187,862

Company

AI-first healthcare technology platform preventing inaccurate payments and reducing waste in the healthcare ecosystem.

What you will do

• Serve as senior business owner for implementing coding review logic across platform including rules engines, workflows, analytics, and automation.
• Define domain-specific automation through rules, bots, agents, machine learning, and AI where appropriate.
• Partner with product and engineering to translate expertise into technical requirements and influence platform roadmap.
• Analyze claims data to identify patterns, risks, and opportunities for logic refinement and automation.
• Conduct research on coding, reimbursement, and regulatory changes to support rule development and policy interpretation.
• Collaborate cross-functionally to advance payment integrity initiatives and ensure scalable outcomes.

Requirements

• Must be legally authorized to work in the U.S.; no visa sponsorship
• Bachelor’s degree in healthcare, business, information systems, data analytics, or equivalent.
• Active credential: CPC, CCS, CCS-P, RHIA with coding expertise (professional, inpatient, outpatient).
• 12+ years in healthcare payment integrity including Coding Review.
• 7+ years analyzing, auditing, or designing solutions for improper payments in health plans or payers.

Nice to have

• Experience translating expertise into scalable logic, rule design, workflow orchestration.
• Strong analytical skills for claims datasets and AI/ML workflows.
• SQL, advanced Excel, BI tools proficiency.
• Experience with AI governance, model monitoring, explainability.
• Proven leadership in scaling payment integrity programs.

Culture & Benefits

• HI-TRUST and SOC2 certified environment with focus on data security and HIPAA compliance.
• Collaborative culture empowering innovation in healthcare AI.
• Full-time US base salary plus total rewards compensation.
• Equal opportunity employer committed to inclusive environment.