Implementation & Validation Assurance: Ensure new and modified payment integrity programs are appropriately validated and implemented as intended. Partner with technical and operational teams to strengthen testing, quality controls, and implementation reliability.
Portfolio Maintenance & Operational Execution: Lead assigned internal and vendor-supported portfolio activities, ensuring effective prioritization, issue resolution, maintenance, and ongoing program performance.
Operational Transformation & Scalability: Identify and implement improvements to processes, workflows, and supporting capabilities across validation, monitoring, maintenance, and knowledge sharing. Leverage technology, automation, and operational best practices to improve efficiency, transparency, and scalability.
Cross-Functional Leadership & Influence: Independently advance complex initiatives, develop evidence-based recommendations, and build alignment across Payment Integrity, Engineering, Data Science, Claims, Compliance, and other stakeholders to achieve measurable results.
Required skills and experience
Bachelor's degree and 6+ years of relevant professional experience, including substantial hands-on payment integrity experience within a health plan or payment integrity vendor.
Strong understanding of healthcare claims, payment integrity edits and audits, claims adjudication, Medicare/CMS reimbursement policies, NCCI/CCI edits, and supporting operational processes.
Demonstrated ability to investigate complex payment integrity issues, analyze root causes, and drive effective resolution.
Strong analytical and technical literacy, including the ability to read and interpret SQL queries, claims data, configuration specifications, validation results, and performance metrics.
Proven experience designing and implementing operational improvements, scalable workflows, or technology-enabled solutions that deliver measurable results.
Demonstrated ability to independently explore and apply analytical tools, technology, and automation to improve workflows, identify opportunities, and develop scalable operational solutions.
Experience collaborating with technical and operational partners to implement, troubleshoot, or improve payment integrity programs.
Demonstrated ability to independently lead complex, multiphase initiatives, exercise sound judgment, and influence cross-functional stakeholders.
Desired skills and experience
Experience with Medicare Advantage and Commercial payment integrity programs.
Experience with vendor-supported claims editing platforms or proprietary payment integrity solutions.
Professional coding certification (e.g., CPC, CCS) or comparable reimbursement expertise.
Experience implementing AI-enabled analytics, automated testing, performance monitoring, or workflow automation to improve payment integrity operations.
#LI-Remote
Salary range: $110,500 - $150,000 / 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.
Founded in 2017, Devoted Health is on a mission to dramatically improve the health and well-being of older Americans by caring for everyone like they are family, and that includes our employees. Our robust and seamlessly integrated care platform merges advanced data and AI access with world-class clinical and service experiences to create a member experience that is unlike the industry norm. To continue building upon our mission, we want to bring together those who share our values, embrace change and advancement, and are enthusiastic about where we're going — all the while bringing their own unique qualities, experiences, and expertise, in hopes of further changing the healthcare experience.
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.
