Payment Integrity Program Development Senior Manager

Job Description

A bit about this role:

At Devoted, our mission is to build trust with our providers and members by ensuring claims are paid accurately and on time with transparent policies. Our Payment Integrity Concept Development Department is at the forefront of this effort, ensuring provider claims are paid correctly, free of errors, and aligned with contractual terms. As our Payment Integrity Program Development Senior Manager, you will serve as a senior payment integrity subject matter expert operating in a high-autonomy, outcomes-driven role. You will help manage and optimize our portfolio of internal and vendor-supported payment integrity edits and audits, ensuring programs operate accurately, efficiently, and effectively. Working collaboratively with Concept Development leaders and operational partners, you will oversee complex initiatives across implementation, validation, performance monitoring, maintenance, and issue resolution. You will combine claims and reimbursement expertise, analytical judgment, and operational insight to identify problems, develop practical solutions, and improve portfolio performance. This role requires independent thinking, professional creativity, and the ability to lead complex, multi-phase work across functions. You will contribute to improvements in savings realization, operational efficiency, turnaround times, and provider experience while helping build scalable processes and capabilities.

Your responsibilities and impact will include:

• Program Operations & Portfolio Management: Manage assigned internal and vendor-supported payment integrity programs across implementation, monitoring, maintenance, and ongoing operational support. Establish priorities, coordinate resources, and ensure effective execution.
• Portfolio Assurance & Optimization: Evaluate program performance, including savings, hit rates, yield, turnaround times, and provider impacts. Identify trends, emerging risks, and opportunities for improvement.
• Complex Root Cause Analysis & Remediation: Independently investigate complex claims, configuration, and operational issues. Determine root causes and impact, develop evidence-based recommendations, and drive resolution across functions.
• Concept Implementation & Validation: Partner with clinical, coding, and reimbursement SMEs to translate concept logic into clear implementation requirements. Collaborate with Engineering, Product, Data Science, and operational teams to support configuration, testing, deployment, and troubleshooting.
• Maintenance, Monitoring & Compliance: Coordinate portfolio maintenance, backsweeps, performance monitoring, regulatory updates, and compliance-related activities. Ensure appropriate controls, documentation, escalation, and follow-through.
• Program & Process Improvement: Identify recurring inefficiencies, capacity constraints, and operational risks. Partner with department leadership to evaluate and implement improvements involving workflows, resource allocation, automation, and technology.
• Data-Driven Decision-Making: Use claims information, operational metrics, analytical tools, and performance trends to investigate issues, evaluate opportunities, and inform recommendations.
• Cross-Functional Leadership & Influence: Develop a clear point of view, constructively challenge assumptions, and bring together stakeholders across Payment Integrity, Claims, Compliance, Engineering, Product, and Data Science to achieve measurable outcomes.
• Project Management & Operational Scalability: Independently lead complex, multi-phase initiatives, manage competing priorities and dependencies, and strengthen repeatable processes, knowledge sharing, and cross-coverage.

Required skills and experience:

• Bachelor's degree and a minimum of 6 years of relevant professional experience within a health plan, payment integrity vendor, healthcare revenue cycle environment, or related healthcare setting.
• Strong expertise in healthcare claims, payment integrity, claims editing, reimbursement, or related healthcare payment operations.
• Demonstrated experience implementing, validating, maintaining, or optimizing payment integrity edits, audits, claims logic, or comparable healthcare operational programs.
• Demonstrated ability to independently investigate complex claims or operational issues, perform root cause analysis, and translate findings into actionable solutions.
• Strong analytical literacy, including the ability to interpret claims data, operational metrics, technical findings, and performance trends.
• Demonstrated ability to lead complex, multi-phase initiatives across multiple functions with limited oversight.
• Strong independent judgment and ability to develop recommendations where data, policy, or operational signals may be incomplete or ambiguous.
• Strong communication, prioritization, and influencing skills, including the ability to align cross-functional partners and drive work through resolution.

Desired skills and experience:

• Experience with Medicare Advantage and prospective and/or retrospective payment integrity programs.
• Experience working with Engineering, Product, or technical configuration teams to implement and troubleshoot claims editing logic.
• Familiarity with CMS guidance, NCCI frameworks, reimbursement policies, coding requirements, and healthcare claims adjudication.
• Experience managing vendor-supported programs, validation operations, maintenance processes, or operational performance improvement.
• Experience using SQL, AI-enabled analytical tools, automation, or other technology to improve payment integrity workflows and performance.

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.