MedReview Inc.

Quality Director – Payment Integrity

MedReview Inc.

full-time

Posted on:

Location Type: Remote

Location: United States

Visit company website

Explore more

✨ AI Apply
Apply

Job Level

Lead

About the role

  • Develop and lead a comprehensive quality assurance and compliance program for PI operations (DRG review, HBA, COB, IBR, data mining, edit engines).
  • Establish and manage audit routines, quality checks, and error tracking mechanisms.
  • Implement remediation plans to address systemic issues and drive continuous improvement.
  • Ensure compliance with CMS guidelines, NCCI edits, LCD/NCD policies, payer rules, and internal standards.
  • Partner with the Delivery Manager to enforce production discipline and reporting controls.
  • Collaborate with the Business Analyst to document quality workflows, SOPs, and acceptance criteria.
  • Analyze quality metrics and produce dashboards/reports for leadership on accuracy, compliance, and error trends.
  • Serve as the compliance subject matter expert, keeping the team current on regulatory and payer policy updates.
  • Lead training sessions and workshops to improve staff accuracy, compliance, and adherence to standards.

Requirements

  • Bachelor’s degree in Healthcare Administration, Nursing, Business, or related field (Master’s or compliance certification a plus).
  • 5–7+ years in healthcare quality management, compliance, or payment integrity operations.
  • Experience implementing audit/QA programs, compliance frameworks, and process controls.
  • Strong knowledge of claims processing and PI functions (DRG, HBA, COB, IBR, edit engines).
  • Strong analytical skills with the ability to identify quality trends and root causes.
  • Excellent organizational and documentation skills.
  • Ability to influence and collaborate across multiple functions.
  • Familiarity with audit tools, data analysis software, and compliance reporting platforms.
  • Lean Six Sigma, CHC (Certified in Healthcare Compliance), or equivalent quality/compliance certification.
  • Prior leadership of a quality/compliance team in a payer, SIU/FWA, or PI environment.
Benefits
  • Health insurance
  • Flexible work arrangements
  • Professional development opportunities
Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
quality assurancecompliance programaudit routineserror trackingdata miningclaims processingDRGHBACOBIBR
Soft Skills
analytical skillsorganizational skillsdocumentation skillsinfluencecollaborationleadershiptrainingcontinuous improvement
Certifications
Bachelor’s degreeMaster’s degreeCHCLean Six Sigma