Job Description

This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Senior Manager, Program Integrity (CPC, RHIT or RHIA required) in United States.

As a Senior Manager, Program Integrity, you will lead initiatives to ensure compliance, accuracy, and quality in medical record auditing and reimbursement processes. This role requires both strategic oversight and hands-on expertise, balancing leadership of auditing teams with active involvement in regulatory compliance, fraud prevention, and system optimization. You will collaborate closely with medical directors, clinical staff, and technology partners to implement effective auditing procedures, ensure appropriate reimbursements, and minimize risks of fraud, waste, and abuse. This is a highly visible leadership opportunity for someone with deep coding knowledge, regulatory awareness, and proven management experience.

Accountabilities

· Lead and oversee medical record coding auditors, ensuring quality, compliance, and timely delivery of audits.

· Implement and optimize auditing procedures, including prepay and post-pay reviews, to improve efficiency and accuracy.

· Oversee regulatory documentation, maintain current standards, and ensure compliance with industry requirements.

· Collaborate with clinical and medical teams to review coding guidelines, reimbursement policies, and code edits.

· Direct new product and vendor implementations, ensuring smooth and timely rollouts.

· Manage system configuration, ticket controls, and change management processes.

· Provide expertise in coding, reimbursement methodologies (APC, DRG, OPPS), and predictive analytics modeling.

· Monitor departmental budgets, track savings, and report on quality and financial outcomes.

· Stay updated on evolving regulations, coding standards, and compliance requirements through research, training, and professional development.

· Recruit, mentor, and manage staff, fostering a high-performance culture.

Requirements

· Bachelor’s degree or equivalent professional experience required.

· Minimum 5 years of experience in medical policy and 5 years in management roles.

· Certified Professional Coder (CPC), RHIT, or RHIA certification required.

· Health plan experience and expertise with clinical editing systems (e.g., Facets) required.

· Strong understanding of medical record auditing, claims payment workflows, and reimbursement methodologies.

· Advanced proficiency in Microsoft Office Suite (Word, Excel, Access) and related healthcare systems.

· Strong programming, systems development, and EDI knowledge preferred.

· Proven skills in problem-solving, project management, and strategic planning.

· Excellent communication, interpersonal, and leadership skills.

· RN license preferred but not required.

Benefits

· Competitive base salary: $92,300 – $161,600 annually, with potential performance-based bonus.

· Comprehensive healthcare coverage including medical, dental, and vision plans.

· 401(k) retirement plan with company match.

· Paid time off and company-recognized holidays.

· Tuition reimbursement and career development opportunities.

· Flexible work options with remote or hybrid possibilities.

· Inclusive and supportive workplace culture, valuing diversity and growth.

Jobgether is a Talent Matching Platform that connects professionals with opportunities worldwide through AI-driven job matching.

· 🔍 Your profile is reviewed using our AI-powered screening process, analyzing your CV and LinkedIn profile.

· 📊 We compare your experience, skills, and achievements with the role’s requirements to generate a match score.

· 🎯 The top 3 matching candidates are automatically shortlisted for the role.

· 🧠 If necessary, our human team conducts an additional review to ensure strong candidates are not overlooked.

This process is skills-based, transparent, and bias-free — focused entirely on your fit for the position. Once the shortlist is complete, it is shared directly with the hiring company. Their internal recruitment team then decides on interviews and next steps.

Thank you for your interest!

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