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.