Payment Integrity Program Development Manager (Healthcare)

Location: Remote USA

Salary: $73,000–$120,000 per year

Company

hirify.global is a healthcare company combining health insurance, clinical care, service, and technology to improve the health and well-being of older Americans.

What you will do

• Manage the full lifecycle of payment integrity edits and audits, from coding and billing hypotheses through rule design and implementation specifications.
• Translate CMS policies, AMA/CPT guidance, NCCI bundling frameworks, LCD/NCD rules, and coding regulations into precise logic with conditions, exclusions, thresholds, and flags.
• Run or interpret data queries and proof-of-concept datasets to validate financial impact and edit efficacy.
• Design defensible payment policies and explanatory narratives that anticipate appeals and provider disputes.
• Optimize released concepts by reducing false positives and provider abrasion while responding to updated behavioral trends.
• Coordinate payment accuracy initiatives with PI Directors, internal audit, SIU, and claims operations.

Requirements

• Bachelor’s degree and at least 4 years of relevant experience in a health plan, payment integrity vendor, or healthcare revenue cycle environment.
• Deep expertise in coding and billing regulations, including CMS policies, LCDs, NCDs, LCAs, NCCI bundling edits, and provider manuals.
• Experience writing logic rules or structural guidelines for claims processing implementation.
• Ability to plan and coordinate initiatives, solve operational obstacles, and meet deadlines.
• Strong analytical literacy, including the ability to read, interpret, and validate data query scripts or advanced spreadsheets.

Nice to have

• Active Certified Professional Coder (CPC) or similar coding certification.
• Experience with institutional and facility billing rules, including MS-DRG, APR-DRG, APC/OPPS, revenue codes, and packaging workflows.
• Experience with Pharmacy Part D and high-cost Part B drug concepts, including dosing, wastage, compounding, and J-code configurations.
• Additional credentials such as CCS, CCS-P, or RHIA.
• Familiarity with Optum/CES, Cotiviti, McKesson, and Medicare Advantage claims rules platforms.

Culture & Benefits

• Individual Contributor role with high autonomy and creative freedom in concept development.
• Employer-sponsored health, dental, and vision plans with low or no premium.
• Generous paid time off and parental leave.
• $100 monthly mobile or internet stipend.
• Stock options and bonus eligibility for full-time employees.
• 401(k) program and a diverse, collaborative work environment.