Senior Payment Integrity Manager

At Devoted Health, we’re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That’s why we’re gathering smart, diverse, and big-hearted people to create a new kind of all-in-one healthcare company — one that combines compassion, health insurance, clinical care, service, and technology - to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. Founded in 2017, we've grown fast and now serve members across the United States.  And we've just started. So join us on this mission!

Job Description

A bit about this role: 

• At Devoted, we know that one of the most important ways we will build trust with our network of providers and members  is to pay claims accurately and on time while having transparent payment policies. Our Payment Integrity Department ensures that provider claims are paid correctly by the responsible party, for eligible members, according to contractual terms, not in error or duplicate, and free of wasteful or abusive practices.

• The Senior Manager, Payment Integrity is a senior operational leader responsible for overseeing the strategy, execution, and performance optimization of the organization's payment integrity programs. This role ensures that both prepayment and post payment audit functions are designed and delivered to achieve savings, reduce error rates, and align with regulatory requirements. The Senior Manager drives operational excellence, manages escalations, collaborates cross-functionally to improve end-to-end audit workflows, and provides guidance to internal teams and external partners.

Your Responsibilities and Impact will include:

• Lead and optimize the execution of enterprise payment integrity initiatives, with accountability for performance across prepay and postpay claims review programs.

• Translate organizational strategy into operational action plans, ensuring alignment with savings goals, audit integrity, and regulatory compliance.

• Partner with analytics, finance, compliance, and tech to identify new audit opportunities, improve processes, and develop scalable solutions.

• Oversee the health of audit pipelines by ensuring work inflow and outflow are properly forecasted, balanced, and executed.

• Monitor program KPIs such as savings, throughput, adjustment timeliness, and audit yield. Take corrective action when performance falls short.

• Use data to identify root causes of inefficiencies or payment errors and lead the development of solutions to reduce future risk.

• Serve as a senior escalation point for complex issues involving claims adjustments, provider disputes, and operational bottlenecks.

• Collaborate with departments such as Claims, Appeals, Provider Relations, and Medical Management to troubleshoot issues and implement improvements across the payment life cycle.

Required skills and experience:

• Bachelor's degree and a minimum of 6 years of relevant experience

• Understanding of US healthcare

• Understanding of claims adjudication, revenue cycle management, and payment integrity

• Ability to collaborate, communicate, and influence horizontally and vertically

• Being comfortable in both leadership and execution roles

• Being comfortable with ambiguity and startup environment

• Ability to incorporate company vision, mission, and values in decision making

Desired skills and experience:
Certified Professional Coder (CPC) certification

Salary range: $104,500 - $155,000 annually

Our ranges are purposefully broad to allow for growth within the role over time. 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 may 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 visio