{"id":1972006,"url":"https://alion.io/job/devoted-health-payment-integrity-program-manager","title":"Payment Integrity Program Manager","company":{"id":58527,"name":"Devoted Health","domain":"devoted.com","url":"https://alion.io/company/devoted-health","size_band":"1001-5000","is_staffing_agency":false,"employer_type":"direct","is_intermediary":false,"listed_via":null,"ats_vendor":"Workday","truth_index":null},"role":"Management","role_family":"Management","seniority":"junior","employment_type":"full_time","work_mode":"on_site","remote_scope":null,"remote_scope_basis":null,"remote_working_hours":null,"hiring_geo_confidence":"structured","locations":["Waltham, United States"],"countries":["US"],"hiring_countries":[],"hiring_countries_total":0,"salary":{"min":73000,"max":120000,"currency":"USD","period":"year","gross":null,"usd_annual":120000},"salary_estimate":null,"experience_years_min":2,"visa_sponsorship":false,"relocation_package":false,"has_equity":true,"technologies":[{"name":"SLI/SLO/SLA","optional":false},{"name":"LLM","optional":true}],"status":"live","first_seen_at":"2026-10-06T19:45:08Z","employer_posted_date":"2026-10-06","last_verified_at":"2026-10-09T18:14:39Z","board_verified":true,"closed_at":null,"days_open":3,"trust":{"level":"ok","repost_count":null,"flags":[],"days_open":3},"description":"Job Description\nA bit about this role:\nThe Payment Integrity Inpatient Program Manager is responsible for overseeing assigned inpatient Payment Integrity programs, including audit, appeals, quality, and review processes across internal teams, offshore staff augmentation, and external vendors. This role is heavily focused on ensuring audit accuracy, timeliness, coding and clinical quality, regulatory compliance, consistency, and defensibility across all assigned program areas. The Program Manager is accountable not only for the quality of audit determinations but also for ensuring audits are reviewed within SLA and that inventory is actively managed to prevent backlogs.\nThe Program Manager partners closely with leadership and operational support teams to ensure audit workflows are executed effectively and on time while maintaining strong oversight of audit quality, turnaround performance, dispute outcomes, vendor performance, and adherence to organizational and regulatory standards.\nYour Responsibilities and Impact will include:\nPerform complex and escalated inpatient Payment Integrity audits, including clinical validation, DRG coding validation, readmission, and hospital bill audit reviews, and provide clear, defensible audit rationale and determinations.\nProvide guidance and oversight to internal staff (offshore and stateside)) and external vendors, managing calibration sessions, feedback loops, education, and ongoing quality monitoring to ensure compliance and adherence to program expectations\nDevelop and maintain program-specific training materials, audit guidance, review standards, and supporting documentation\nPerform quality reviews and trend analysis to ensure coding, clinical, and audit findings are accurate, defensible, and aligned with regulatory, contractual, and organizational requirements\nMonitor program metrics, dispute trends, and vendor results, partnering with leadership to identify root causes, address quality concerns, and drive continuous improvement efforts\nCollaborate with internal and external stakeholders to resolve complex audit, coding, clinical, and escalation-related issues, serving as the primary subject matter expert for assigned program areas\nSupport dispute and appeals management activities, including escalation review, audit rationale review, and corrective action planning\nSupport the implementation of new audit concepts, review methodologies, and program enhancements to align with evolving business and regulatory needs\nRequired skills and experience:\n2-3 years of experience in healthcare audit, Payment Integrity, coding review, clinical documentation review, or compliance\nStrong clinical and inpatient coding knowledge required; CCS, RHIA, RHIT, RN, or equivalent inpatient coding/clinical validation experience required. Demonstrated expertise in inpatient DRG coding and validation strongly preferred.\nDemonstrated experience with inpatient DRG assignment and validation, including ICD-10-CM coding, principal and secondary diagnosis assignment, MCC/CC identification, POA indicators, and inpatient clinical documentation review, as well as severity of illness/risk of mortality concepts and readmission logic.\nDemonstrated experience reviewing medical records to ensure audit accuracy, coding/clinical correctness, compliance, and defensibility of determinations\nExperience operating within structured audit programs, including applying defined criteria, documenting rationale, and ensuring consistency and quality of audit outcomes\nAbility to interpret clinical and/or coding documentation to support audit decisions and resolve documentation gaps or discrepancies\nExperience collaborating across clinical, coding, audit, and operational teams in a complex healthcare environment\nStrong analytical skills with the ability to assess audit trends, root causes, and documentation gaps impacting program performance and quality outcomes\nStrong operational discipline and the ability to stay organized amidst a wide variety of responsibilities\nProven experience in training payment integrity audits\nDesired skills and experience:\nBachelor’s Degree \nStrong leadership, communication, and interpersonal skills to effectively engage internal and external stakeholders\nExperience managing offshore vendors\nAbility to handle multiple priorities and meet deadlines in a fast-paced environment\nCuriosity and hands-on experience with AI tools, automation, or LLM-based workflows in operational settings\nSalary range: $73,000 - 120,000 annually\nThe 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.\nOur Total Rewards package includes:\nEmployer sponsored health, dental and vision plan with low or no premium\n\nGenerous paid time off\n\n$100 monthly mobile or internet stipend\n\nStock options for all employees\n\nBonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles\n\nParental leave program\n\n401K program\n\nAnd more....\n\n*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.\nFounded 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.\nDevoted 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.\nAs 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.","description_format":"text","description_chars":7368,"description_truncated":false,"requirements":{"experience_years_min":2,"management_years_min":null,"team_size_min":null,"manages_managers":false,"education":{"level":"bachelor","optional":false},"security_clearance":false,"languages":[]},"benefits":["401k plan","Parental leave","Stock options"],"hiring_locations":[],"hiring_excludes":[],"relocation_offered":false,"industries":["Telemedicine & Virtual Care","Health Insurance & Benefits"],"lifecycle":[{"event":"open","at":"2026-10-06T19:45:08Z"}],"visa":[],"liveness":{"score":88,"band":"hot","label":"Hiring now","p_open":1,"p_active":0.879,"p_room":1,"age_days":2,"expected_fill_days":14,"reasons":["conf:3","velocity","win:early","comp:junior"],"computed_at":"2026-10-09T06:01:00Z"},"pay":{"stated_usd_annual":120000,"is_top_pay":true},"html_url":"https://alion.io/job/devoted-health-payment-integrity-program-manager","json_url":"https://alion.io/job/devoted-health-payment-integrity-program-manager.json","meta":{"generated_at":"2026-10-10T01:44:38Z","cache_seconds":300,"methodology":"https://alion.io/methodology","terms":"https://alion.io/terms","contact":"https://alion.io/contact","api":"https://alion.io/developers","about":"Alion is a live layer of people, companies and AI agents: who they are, whether they are real and active right now, what they do and how to work with them, readable by people and by agents and paid per call.","catalog":"https://alion.io/catalog.json","usage":{"tier":"crawler","counted_by":"address","units_charged":1,"used_today":3128,"day_limit":5000,"remaining_today":1872,"minute_limit":60,"resets_at":"2026-10-11T00:00:00Z"}},"offers":[{"id":"company.slices","title":"One company in depth, by slice","status":"live","price":{"credits":0.02,"usd":0.002,"plus_per_slice":{"credits":0.05,"usd":0.005}},"unit":"per company, plus each slice with data","note":"the employer in depth","call":{"mcp_tool":"get_company","arguments":{"id":58527},"rest":"https://alion.io/mcp/rest/get_company?id=58527"},"human":"https://alion.io/catalog?offer=company.slices&for=job%2Fdevoted-health-payment-integrity-program-manager"},{"id":"market.stats","title":"A market slice: pay, demand and time to fill","status":"live","price":{"credits":1,"usd":0.1},"unit":"per slice","note":"pay, demand and time to fill for this role and place","call":{"mcp_tool":"market_stats"},"human":"https://alion.io/catalog?offer=market.stats&for=job%2Fdevoted-health-payment-integrity-program-manager"},{"id":"job.search","title":"Open jobs by role, technology, place, pay and visa","status":"live","price":{"credits":0.02,"usd":0.002},"unit":"per posting in a list","note":"similar open postings","call":{"mcp_tool":"search_jobs"},"human":"https://alion.io/catalog?offer=job.search&for=job%2Fdevoted-health-payment-integrity-program-manager"},{"id":"company.verify","title":"Is this company real and active right now","status":"pilot","price":null,"unit":"per company","request":{"url":"https://alion.io/catalog/request","method":"POST","body":"{\"offer\": \"company.verify\", \"for\": \"job/devoted-health-payment-integrity-program-manager\", \"note\": \"what you need it for\"}"},"human":"https://alion.io/catalog?offer=company.verify&for=job%2Fdevoted-health-payment-integrity-program-manager"}]}