RN Certified Payment Integrity Director

Job Summary

Serving as a key subject matter expert, the full-time RN Certified Payment Integrity Director will manage payment integrity initiatives, provide clinical and coding expertise for complex inquiries, and lead efforts to identify root causes of disputes, all while working remotely.

Key responsibilities

• Serve as the primary Subject Matter Expert (SME) for payment integrity initiatives, providing clinical and technical rationales to leadership
• Engage with provider-facing teams to resolve high-stakes escalations using deep coding and clinical knowledge
• Conduct deep-dive reviews of escalations to identify root causes and improve clinical coding practices

Required qualifications

• Active Registered Nurse (RN) license and/or Certified Professional Coder (CPC/CPMA) designation
• 8+ years of experience in healthcare payment integrity, medical audit, or revenue cycle leadership
• Proven ability to present complex clinical or coding rationales to executive leadership
• Experience in resolving high-stakes technical disputes through clinical authority
• Demonstrated leadership experience with a track record of mentoring staff