RN Payment Integrity Manager

Job Summary

Leading a team focused on Payment Integrity initiatives, the full-time RN Payment Integrity Manager will oversee potentially preventable readmissions, ensuring payment accuracy and compliance with internal policies and regulatory requirements in a remote setting.

Key responsibilities

• Manage Payment Integrity initiatives related to readmissions, cost recovery, and payment accuracy
• Collaborate with various teams to design and monitor readmission and DRG-related strategies
• Provide operational oversight and leadership to teams conducting readmission reviews, ensuring adherence to standards

Required qualifications

• Bachelor's degree in a relevant field; a master's degree is preferred
• 5+ years of experience in Payment Integrity, including readmission review and DRG validation
• 3+ years of leadership experience managing teams
• Active Health Information Management or coding credentials required, such as RHIT, RHIA, CCS, CIC, or CCDS
• Experience with Diagnosis Related Group encoder and grouper tools