Director, Payment Integrity

Devoted Health • Waltham, MA

1d • $182,000 - $217,000

About The Position

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 Director of Payment Integrity will be a subject matter expert (SME) for clinical, coding, and technical payment accuracy. This role is designed for a credentialed expert who can bridge the gap between complex clinical and coding data and organizational strategy. The Director will provide the technical, coding, and clinical payment integrity rationale for internal stakeholders and will support provider-facing teams to resolve complex inquiries through transparency and evidence-based policy.

Requirements

• Must hold an active Registered Nurse (RN) license and/or Certified Professional Coder (CPC/CPMA) designation.
• 8+ years in healthcare payment integrity, medical audit, or revenue cycle leadership.
• Proven ability to present complex clinical or coding rationales to executive leadership.
• Experience resolving high-stakes technical disputes through clinical authority and mastery of payment policy.
• Proven track record of leading teams and mentoring staff to drive successful program outcomes.
• Comfort with emerging technologies and a strong willingness to adopt an "AI-first" mindset to optimize workflows and audit logic.
• Thrives in a fast-paced, high-growth, or start-up environment; highly comfortable navigating ambiguity and evolving business needs.

Nice To Haves

• Familiarity with deploying AI-enabled workflows or automation to solve business challenges.

Responsibilities

• Serve as the primary Subject Matter Expert (SME) for payment integrity initiatives.
• Provide clinical, coding, and technical rationales for audit programs to Compliance, Network Management, and Operations leadership to ensure total organizational alignment and policy defensibility.
• Provide clinical and coding expertise to provider-facing teams for complex inquiries.
• Focus on resolving high-stakes escalations by applying deep coding, clinical, and policy knowledge to foster transparency and mutual understanding with the provider community.
• Perform deep-dive reviews of escalations to identify root causes.
• Use these findings to refine clinical coding practices and internal logic, proactively addressing systemic issues to reduce future dispute volume.
• Offer technical and clinical guidance to the teams handling audits and disputes.
• Ensure that all findings are consistent, evidence-based, and strictly aligned with contractual obligations and industry-standard coding guidelines.
• Lead the development of internal "best practice" guides and clinical logic resources.
• As necessary, support the creation of provider-facing materials to clarify and define billing expectations and reduce the frequency of future escalations.
• Collaborate with the Network team to ensure contract language reflects current clinical coding standards and work with Compliance to maintain the highest levels of program integrity.

Benefits

• 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....

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Education Level: No Education Listed