Director, Payment Integrity

Job Description A bit about this role: At Devoted, we know that one of the most important ways we will build trust with our network of providers and members is to pay claims accurately and on time while having transparent payment policies. Our Payment Integrity Department ensures that provider claims are paid correctly by the responsible party, for eligible members, according to contractual terms, not in error or duplicate, and free of wasteful or abusive practices. The Director of Payment Integrity will be a subject matter expert (SME) for clinical, coding, and technical payment accuracy. This role is designed for a credentialed expert who can bridge the gap between complex clinical and coding data and organizational strategy. The Director will provide the technical, coding, and clinical payment integrity rationale for internal stakeholders and will support provider-facing teams to resolve complex inquiries through transparency and evidence-based policy. Your Responsibilities and Impact will include: Executive Liaison & Program Advocacy: Serve as the primary Subject Matter Expert (SME) for payment integrity initiatives. Provide clinical, coding, and technical rationales for audit programs to Compliance, Network Management, and Operations leadership to ensure total organizational alignment and policy defensibility. Strategic Provider Engagement: Provide clinical and coding expertise to provider-facing teams for complex inquiries. Focus on resolving high-stakes escalations by applying deep coding, clinical, and policy knowledge to foster transparency and mutual understanding with the provider community. Root Cause & Logic Improvement: Perform deep-dive reviews of escalations to identify root causes. Use these findings to refine clinical coding practices and internal logic, proactively addressing systemic issues to reduce future dispute volume. Audit & Dispute SME Support: Offer technical and clinical guidance to the teams handling audits and disputes. Ensure that all findings are consistent, evidence-based, and strictly aligned with contractual obligations and industry-standard coding guidelines. Internal Knowledge & Transparency: Lead the development of internal "best practice" guides and clinical logic resources. As necessary, support the creation of provider-facing materials to clarify and define billing expectations and reduce the frequency of future escalations. Cross-Functional Policy Development: Collaborate with the Network team to ensure contract language reflects current clinical coding standards and work with Compliance to maintain the highest levels of program integrity. Required Skills and experience: Clinical/Coding Credentials: Must hold an active Registered Nurse (RN) license and/or Certified Professional Coder (CPC/CPMA) designation. Experience: 8+ years in healthcare payment integrity, medical audit, or revenue cycle leadership. Executive Presence: Proven ability to present complex clinical or coding rationales to executive leadership. Escalation Management: Experience resolving high-stakes technical disputes through clinical authority and mastery of payment policy. Leadership Experience: Proven track record of leading teams and mentoring staff to drive successful program outcomes. Tech Advocacy & AI Readiness: Comfort with emerging technologies and a strong willingness to adopt an "AI-first" mindset to optimize workflows and audit logic. Adaptability & Agility: Thrives in a fast-paced, high-growth, or start-up environment; highly comfortable navigating ambiguity and evolving business needs. Desired Skills and experience: Familiarity with deploying AI-enabled workflows or automation to solve business challenges. #LI-Remote Salary Range: $182,000-$217,000 / year The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job. Our Total Rewards package includes: Employer sponsored health, dental and vision plan with low or no premium Generous paid time off $100 monthly mobile or internet stipend Stock options for all employees Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles Parental leave program 401K program And more.... *Our total rewards package is for full time employees only. Intern and Contract positions are not eligible. Healthcare equality is at the center of Devoted’s mission to treat our members like family. We are committed to a diverse and vibrant workforce. At Devoted Health, we’re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That’s why we’re gathering smart, diverse, and big-hearted people to create a new kind of all-in-one healthcare company — one that combines compassion, health insurance, clinical care, service, and technology - to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. Founded in 2017, we've grown fast and now serve members across the United States. And we've just started. So join us on this mission! Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values and the way we do business. As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment. We have been made aware of instances of fraudulent job postings and/or fraudulent recruiting activity by individuals purporting to represent Devoted Health. These fraudulent schemes often seek monetary contributions or payments from job seekers (such as for “start up costs” or “equipment”), or seek to collect sensitive personal information. These job postings and offers are NOT authorized by Devoted Health and Devoted is not responsible for fraudulent offers, personal information that you may have disclosed, or payments made to third parties purporting to represent Devoted. We have reported this matter and are cooperating with law enforcement agencies. Devoted Health will never ask for financial commitment or contribution from a candidate at any stage of the recruitment process.