Director, Payment Integrity - Edit Programs (Healthcare)

Location: Remote-MO

Salary: $107,700.00–$199,300.00 per year

Company

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

What you will do

• Oversee prepay editing and retrospective audits addressing coding, pricing, waste, abuse, and payment accuracy.
• Design, develop, and implement payment integrity edit and audit programs, policies, procedures, and continuous improvement processes.
• Interpret audit results, develop action plans, and present findings to senior management.
• Monitor state and federal laws and regulations and update payment integrity policies and procedures accordingly.
• Develop and deliver coding education and training for providers and employees.
• 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.
• At least 7 years of experience in finance, accounting, operations, or auditing.
• At least 7 years of compliance or ERM experience preferred.
• Experience in claims operations preferred.
• Ability to maintain compliance with state and federal regulations and company policies.

Culture & Benefits

• Remote work arrangement with a flexible approach to remote, hybrid, field, or office schedules.
• Health insurance, 401(k), stock purchase plans, tuition reimbursement, paid time off, and holidays.
• Compensation may include additional incentives and is adjusted based on job-related factors.
• Equal opportunity employment and consideration under applicable fair-chance laws.