RN Payment Integrity Manager

Job Summary

Leading a team of Medical Bill Reviewers, the full-time RN Payment Integrity Manager will oversee high-quality facility bill audits, ensuring accuracy and compliance while managing operational workflows in a remote setting.

Key responsibilities

• Directly manage and coach a team of Medical Bill Reviewers, monitoring performance metrics and ensuring timely completion of audits
• Serve as the clinical authority for audit quality, reviewing escalated cases and maintaining clinical review standards
• Collaborate with cross-functional teams to optimize audit workflows and contribute to client-facing reporting and escalations

Required qualifications

• Must hold an active RN license or higher-level clinical license
• 5+ years of experience in medical bill review, facility coding, or clinical auditing, with at least 2+ years in a leadership role
• Deep expertise in Itemized Bill Review (IBR) and facility claim auditing
• At least one relevant coding/audit certification preferred (CPC, CIC, CRC, CPMA, etc.)
• Strong knowledge of national coding guidelines and HIPAA/PHI compliance standards