State Licensed Payment Integrity Director

Job Summary

To lead the strategy and performance of Payment Integrity review programs, the full-time remote State Licensed Payment Integrity Director will manage a team of Managers and oversee clinical and operational functions, ensuring audit quality and compliance while driving program growth and efficiency.

Key responsibilities

• Own the strategy and operating model for Payment Integrity review programs, including audit workstreams
• Lead and develop teams, setting performance standards and ensuring accountability for audit accuracy and throughput
• Serve as the senior clinical authority for audit quality, establishing methodologies and overseeing compliance with national coding guidelines

Required qualifications

• 8+ years of experience in medical bill review, clinical auditing, or payment integrity, with 4+ years in a leadership role
• Deep expertise in various Payment Integrity review types and proven track record of owning program-level KPIs
• Strong knowledge of national coding guidelines (CPT, ICD-10, HCPCS) and experience with client executive interactions
• Demonstrated ability to build and scale teams, including developing managers and establishing training programs
• Active RN license or higher-level clinical license strongly preferred; equivalent senior clinical/coding leadership background will be considered