Payment Integrity Specialist

TL;DR

Payment Integrity Specialist (Finance/MedTech): Ensuring accurate reimbursement and regulatory compliance across payer relationships with an accent on auditing payments against contracts and MFN laws. Focus on identifying discrepancies, mitigating financial risks, and optimizing revenue integrity through cross-functional collaboration.

Location: Remote (US-based)

Salary: $70,000 - $86,000 USD

Company

hirify.global is a leader in genomics and genetic testing, dedicated to diagnosing rare disorders and enhancing patient care through cutting-edge science and clinical expertise.

What you will do

• Monitor internal and external audits related to claims, payments, and refunds.
• Conduct periodic audits of payer contracts to ensure compliance with MFN laws.
• Review and process refund requests while ensuring accurate payment posting.
• Validate that payments align with negotiated payer contracts and MFN provisions.
• Partner with appeals, credentialing, and market access teams to resolve payment issues.
• Provide process improvement recommendations to operational teams.

Requirements

• Bachelor’s degree in healthcare administration, finance, or related field.
• 3–5 years of experience in medical billing, payment integrity, or payer contract auditing.
• Strong understanding of MFN laws, payer policies, and healthcare reimbursement models.
• Proficiency in claims management systems and data analytics tools.
• Excellent communication and documentation abilities.
• Must be authorized to work in the United States.

Nice to have

• CPCS or similar certification.

Culture & Benefits

• Comprehensive health, dental, vision, and life insurance.
• 401k Retirement Savings Plan with company contribution.
• Employee Stock Purchase Plan.
• Up to 22 weeks of fully paid parental leave.
• Support programs for family planning, pregnancy, and postpartum care.
• Collaborative, fast-moving environment focused on patient outcomes.