Director, Payment Integrity - Appeals & Disputes (Healthcare)

Location: Remote-MO, United States

Salary: $107,700–$199,300 per year

Company

hirify.global is a diversified national healthcare organization serving 28 million members.

What you will do

• Oversee prepay editing, waste and abuse reviews, and retrospective audits related to coding and pricing issues.
• Interpret audit results, create action plans, and present findings to senior management.
• Design and implement payment integrity edit and audit programs, policies, and procedures.
• Monitor regulatory changes and maintain compliance with state and federal requirements.
• Develop provider and employee training to improve operational processes and coding accuracy.
• Direct and lead Prepay Compliance Managers in reducing waste, abuse, and fraud.

Requirements

• Bachelor’s degree in accounting, finance, nursing, operations management, healthcare, or a related field, or equivalent experience.
• 7+ years of experience in finance, accounting, operations, or auditing.
• Experience in claims operations is preferred.
• 7+ years of Compliance/ERM experience is preferred.
• Remote-MO work location requirement.

Culture & Benefits

• Health insurance, 401(k), and stock purchase plans.
• Tuition reimbursement, paid time off, and holidays.
• Flexible workplace approach with remote, hybrid, field, or office schedules.
• Competitive pay adjusted for skills, experience, education, and other job-related factors.