Payment Integrity Program Manager

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Payment Integrity Program Manager based in United States.

• This role oversees inpatient Payment Integrity programs spanning audit, appeals, quality, and review operations.
• You will ensure audit determinations are accurate, timely, clinically sound, and defensible.
• The position combines hands-on clinical and coding expertise with program oversight and operational leadership.
• You will collaborate with internal teams, offshore staff, and external vendors to maintain consistent standards.
• The role also uses quality analysis, trend monitoring, and root-cause assessment to improve program performance.
• As a subject matter expert, you will help resolve complex cases and support evolving audit methodologies and regulatory requirements.
• This is a fully remote opportunity with broad influence across payment integrity operations and quality outcomes.