Payment Integrity Principal - Coding Review

TL;DR

Payment Integrity Principal (Coding Review): Serve as senior authority for system-level payment integrity strategy, logic, and enablement across AI platform with an accent on translating coding expertise into scalable rules, workflows, analytics, and AI-driven capabilities. Focus on designing cohesive automation strategies, ensuring technical soundness, operational viability, and alignment with platform evolution.

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

Salary: $125,241 - $187,862 (US base, full-time)

Company

AI-first healthcare technology platform preventing inaccurate payments and reducing waste, with 35 years of pre-pay editing expertise, HI-TRUST/SOC2 certified, and recognized as 2025 Best in KLAS.

What you will do

• Serve as senior business owner for implementing Coding Review logic across platform, including rules engines, workflows, analytics, and automation.
• Define automation strategies for domain logic via rules, bots, agents, ML, and AI decisioning.
• Partner with product, engineering, analytics, and operations to translate expertise into technical requirements and influence platform roadmap.
• Analyze claims data, conduct coding/reimbursement research, and identify automation opportunities to reduce false positives and manual effort.
• Ensure rule logic, workflows, and strategies align with operational reality, regulatory changes, and future platform vision.
• Act as thought leader in cross-functional initiatives advancing payment integrity maturity and scalability.

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 professional, inpatient/outpatient facility coding expertise.
• 12+ years in healthcare payment integrity, including Coding Review.
• 7+ years analyzing/auditing/designing solutions to prevent improper payments in health plan, vendor, or payer environment.

Nice to have

• Experience translating expertise into scalable logic, rule design, workflow orchestration, AI/ML workflows.
• Advanced analytical skills with claims datasets, SQL, BI tools, performance metrics.
• Partnering with product/engineering on specs, build, testing, deployment.
• AI governance, explainability, human-in-the-loop controls.
• Scaling payment integrity programs, reducing false positives/manual effort.

Culture & Benefits

• Inclusive environment as Equal Opportunity Employer.
• Collaborative success, empowering employees.
• Total rewards compensation beyond base salary.