State Licensed Payment Integrity Director

Job Summary

To lead and scale Payment Integrity review programs, the full-time salaried State Licensed Payment Integrity Director will manage a team of Managers, oversee clinical and operational strategies, and ensure audit quality and compliance in a remote setting.

Key responsibilities

• Own the strategy and operating model for Payment Integrity review programs, including setting performance standards and accountability
• Serve as the senior clinical authority for audit quality, ensuring adherence to national coding guidelines and managing high-complexity audit disputes
• Develop and retain a strong team of Managers, establishing career paths and training programs to foster growth within the organization

Required qualifications

• 8+ years of experience in medical bill review, clinical auditing, or payment integrity, with at least 4 years in a leadership role
• Deep expertise in various Payment Integrity review types, including facility claim auditing and Itemized Bill Review (IBR)
• Proven track record of owning program-level KPIs and driving measurable improvements
• Strong knowledge of national coding guidelines and payer-specific audit policies
• Active RN license or higher-level clinical license preferred; equivalent senior clinical/coding leadership background considered