Director, Payment Integrity (Healthcare)

TL;DR

Director, Payment Integrity (Healthcare): Leading clinical, coding, and technical payment accuracy initiatives to ensure transparent and compliant claims processing with an accent on evidence-based policy and root cause analysis. Focus on bridging complex clinical data with organizational strategy and resolving high-stakes provider disputes through expert clinical authority.

Location: Remote (USA)

Salary: $182,000–$217,000 / year

Company

hirify.global is an all-in-one healthcare company dedicated to improving the well-being of older Americans by integrating health insurance, clinical care, and technology.

What you will do

• Serve as the primary Subject Matter Expert for payment integrity, providing clinical and coding rationales to leadership.
• Resolve high-stakes provider escalations by applying deep policy knowledge and clinical expertise.
• Perform deep-dive reviews to identify root causes of disputes and refine internal clinical logic.
• Guide audit and dispute teams to ensure findings align with contractual obligations and industry standards.
• Develop internal best practice guides and provider-facing materials to clarify billing expectations.
• Collaborate with Network and Compliance teams to ensure contract language reflects current coding standards.

Requirements

• Must hold an active Registered Nurse (RN) license and/or Certified Professional Coder (CPC/CPMA) designation.
• 8+ years of experience in healthcare payment integrity, medical audit, or revenue cycle leadership.
• Proven ability to present complex clinical or coding rationales to executive leadership.
• Experience resolving high-stakes technical disputes through clinical authority.
• Comfort with emerging technologies and willingness to adopt an AI-first mindset.
• Must be based in the United States.

Nice to have

• Familiarity with deploying AI-enabled workflows or automation to solve business challenges.

Culture & Benefits

• Employer-sponsored health, dental, and vision plans with low or no premiums.
• Generous paid time off and parental leave program.
• 401K program with company contributions.
• $100 monthly mobile or internet stipend.
• Stock options for all employees.