Payment Integrity Manager
Lyric - Clarity in motion.
full-time
Posted on:
Location Type: Remote
Location: United States
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Salary
💰 $122,425 - $183,638 per year
About the role
- Develop and operate Coding Review workflows across pre-pay and post-pay programs
- Perform claim review directly to support volume, validate workflows, and ensure early consistency
- Oversee daily review execution, including work allocation, throughput, turnaround time, and issue resolution
- Identify operational gaps and implement process improvements within established policies and procedures
- Develop and maintain the Coding Review training program, including onboarding materials, reference guidance, and ongoing education
- Ensure reviewers are trained to apply Coding Review guidelines consistently
- Support reviewer onboarding and ongoing skill development
- Develop and run the Coding Review quality assurance program, including audits, calibration, and feedback loops
- Conduct quality audits and calibration activities
- Monitor quality trends, identify root causes, and implement corrective actions
- Serve as an escalation point for complex or ambiguous reviews
- Support guideline clarification and workflow validation through direct review experience
- Build and manage the Coding Review team, including hiring, onboarding, coaching, and performance management
- Provide day-to-day guidance to reviewers within established company policies and processes
- Develop detailed work plans and timelines to meet operational objectives
- Provide execution level operational and clinical support during Coding Review implementations
- Respond to customer questions related to review workflows, guideline application, and quality processes
- Support customer confidence by clearly explaining Coding Review execution and quality processes
Requirements
- Active, unrestricted Registered Nurse license
- Bachelor’s degree or equivalent experience
- Three or more years of clinical experience in an acute, ambulatory, or procedural care setting, with the ability to apply clinical judgment to coding and documentation review
- Five or more years of experience in healthcare payment integrity, clinical coding review, auditing, or related functions
- Demonstrated experience leading, coaching, and developing clinical or coding review staff, including direct people management responsibility
- Proven ability to set performance expectations, provide ongoing feedback, and address performance issues within a production environment
- Demonstrated hands-on claim review experience, including complex or ambiguous scenarios
- Strong knowledge of professional, facility, and ancillary coding methodologies, payment policy interpretation, and clinical documentation standards
- Experience developing and delivering training or onboarding programs for review staff
- Ability to travel up to 20 percent, including internationally
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
clinical coding reviewauditingpayment integrityquality assuranceclaim reviewcoding methodologiesclinical documentation standardsprocess improvementstraining program developmentperformance management
Soft Skills
leadershipcoachingcommunicationproblem-solvingteam managementorganizational skillsfeedback provisioncustomer supporttraining deliveryclinical judgment
Certifications
Registered Nurse license