Director, Payment Integrity

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Director, Payment Integrity based in United States. This is a strategic leadership opportunity for an experienced healthcare payment integrity professional passionate about driving accuracy, transparency, and operational excellence across complex claims and reimbursement processes. In this role, you will serve as a key subject matter expert, influencing organizational strategy while ensuring payment integrity programs are clinically sound, compliant, and evidence-based. Working cross-functionally with compliance, provider relations, operations, and network teams, you will help strengthen trust with providers and members by improving payment accuracy and reducing waste. The position offers a highly collaborative, remote-first environment where innovation, technology adoption, and continuous improvement are highly valued. This is an ideal opportunity for a credentialed clinical or coding expert looking to make a meaningful impact at scale within a rapidly growing healthcare organization. \n Accountabilities: Serve as the primary subject matter expert for payment integrity initiatives, providing clinical, coding, and technical guidance to leadership and cross-functional stakeholders. Support provider-facing teams in resolving complex escalations and payment disputes through evidence-based analysis and transparent communication. Conduct root cause investigations to identify trends, improve audit logic, and enhance payment accuracy across the organization. Provide clinical and coding expertise to audit and dispute resolution teams, ensuring consistency with contractual obligations and industry standards. Develop internal best-practice resources, educational materials, and payment integrity documentation to strengthen organizational knowledge. Collaborate with compliance, network, and operational teams to align payment policies, contract language, and regulatory requirements. Advocate for process improvements, technology adoption, and innovative approaches to enhance payment integrity outcomes and operational efficiency. Requirements Active Registered Nurse (RN) license and/or Certified Professional Coder (CPC/CPMA) credential required. 8+ years of experience in healthcare payment integrity, medical auditing, revenue cycle management, or related leadership roles. Strong expertise in clinical coding, payment policy interpretation, claims auditing, and healthcare reimbursement processes. Demonstrated ability to communicate complex clinical and coding concepts to executive stakeholders and diverse audiences. Proven experience managing high-priority escalations and resolving technical disputes with providers. Previous leadership experience with a track record of mentoring teams and driving successful program outcomes. Comfort working with emerging technologies and a willingness to embrace AI-driven tools and workflows. Strong analytical thinking, problem-solving skills, and the ability to thrive in dynamic, fast-paced environments. Experience with automation initiatives or AI-enabled healthcare solutions is considered a plus. Benefits Competitive annual salary ranging from $182,000 to $217,000, based on experience, qualifications, and location. Comprehensive medical, dental, and vision coverage with low or no employee premiums. Generous paid time off package. $100 monthly internet or mobile connectivity stipend. Stock options available for eligible employees. Parental leave program. 401(k) retirement savings plan. Fully remote work environment. Additional wellness, financial, and employee support programs. \n How Jobgether works: We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best! Why Apply Through Jobgether? Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.

#LI-CL1