Payment Integrity Program Manager

Job Summary

Overseeing assigned inpatient Payment Integrity programs, the full-time remote Payment Integrity Program Manager will manage audits, appeals, and quality review processes while ensuring compliance and accuracy across internal teams and external vendors.

Key responsibilities

• Perform complex inpatient Payment Integrity audits and provide clear audit rationale and determinations
• Guide and oversee internal staff and external vendors, managing training and quality monitoring to ensure compliance
• Monitor program metrics and collaborate with stakeholders to resolve complex audit and coding issues

Required qualifications

• 2-3 years of experience in healthcare audit, Payment Integrity, or coding review
• Strong clinical and inpatient coding knowledge; CCS, RHIA, RHIT, RN, or equivalent experience required
• Experience with inpatient DRG assignment and validation, including ICD-10-CM coding
• Demonstrated experience reviewing medical records for audit accuracy and compliance
• Ability to collaborate across clinical, coding, and operational teams in a complex healthcare environment