Payment Integrity Product Development Specialist

MedReview Inc.

Payment Integrity Product Development Specialist at MedReview supporting development of SNF audit products. Ideal for a clinical leader with expertise in SNF regulations and payment integrity.

Posted 6/25/2026full-timeRemote • 🇺🇸 United StatesMid-LevelSeniorWebsite

About the role

Key responsibilities & impact

Serve as the primary SNF domain expert for the product development team by translating regulatory and clinical requirements into audit rules, workflows and operational processes.
Validate and refine SNF audit methodology, including medical necessity criteria, documentation standards and coding requirements.
Define MVP scope, roadmap enhancements and implementation readiness.
Apply deep knowledge of CMS SNF regulations, PDPM, MDS/RAI, therapy documentation and state Medicaid policies.
Monitor regulatory updates and recommend product adjustments as needed.
Define and validate claim selection logic, risk indicators and scoring models.
Develop and validate end-to-end workflows, including intake, clinical review, provider outreach and appeals.
Define SLA expectations for turnaround times, provider response windows and internal review cycles.
Support training for clinical reviewers, auditors and provider engagement teams.
Define reporting needs for audit outcomes, savings, provider trends and operational KPIs.
Partner with analytics to ensure dashboards and reporting tools are accurate and actionable.
Identify opportunities for continuous improvement based on audit results.
Serve as SME during product implementation, ensuring all components are ready for deployment.

Requirements

What you’ll need

5-10+ years of experience in Skilled Nursing Facility clinical operations, utilization management, payment integrity or audit programs.
Strong understanding of CMS SNF regulations, PDPM, MDS/RAI, therapy documentation and medical necessity criteria.
Experience developing or executing clinical audit programs for Medicaid, Medicare and/or commercial payors.
Familiarity with claims data, coding standards and documentation requirements.
Ability to translate complex clinical and regulatory concepts into clear operational and product requirements.
Strong communication, analytical and data comprehension skills.
Preferred Experience RN, PT, OT, SLP or other clinical licensure.
Experience with payment integrity vendors, health plans or state Medicaid agencies.
Background in product development or clinical audit solution design.
Experience developing claims scoring models or working with analytics teams.

Benefits

Comp & perks

🌐 Worldwide ❌ Jobs You've Hidden ⭐️ Saved Jobs ✅ Applied Jobs ✉️ Email Alerts 👤 Account MedReview Inc. Website LinkedIn All Job Openings 201 - 500 employees ⚕️ Healthcare Insurance 💸 Finance Healthcare Insurance
Finance MedReview Inc. is a leading provider of advanced payment integrity solutions, specializing in healthcare claims. They work with a wide range of clients, including health plans, government agencies, and payors, to reduce unnecessary waste and save billions of dollars. Their team of highly trained physicians, registered nurses, and certified coders conduct thorough clinical and coding reviews to identify inaccuracies in healthcare claims. MedReview employs proprietary algorithms to analyze complex data and detect suspicious payment trends, offering a unique blend of clinical expertise and advanced technology to maximize efficiencies and improve healthcare cost management. Payment Integrity Product Development Specialist 🔥 1 minute ago 🇺🇸 United States – Remote ⏰ Full Time 🟡 Mid-level 🟠 Senior 🪄 Product Specialist Apply Now Find Hiring Managers Customize resume + cover letter Report problem ☆ Save ☑️ Mark as applied ❌ Hide 📋 Description
Serve as the primary SNF domain expert for the product development team by translating regulatory and clinical requirements into audit rules, workflows and operational processes.
Validate and refine SNF audit methodology, including medical necessity criteria, documentation standards and coding requirements.
Define MVP scope, roadmap enhancements and implementation readiness.
Apply deep knowledge of CMS SNF regulations, PDPM, MDS/RAI, therapy documentation and state Medicaid policies.
Monitor regulatory updates and recommend product adjustments as needed.
Define and validate claim selection logic, risk indicators and scoring models.
Develop and validate end-to-end workflows, including intake, clinical review, provider outreach and appeals.
Define SLA expectations for turnaround times, provider response windows and internal review cycles.
Support training for clinical reviewers, auditors and provider engagement teams.
Define reporting needs for audit outcomes, savings, provider trends and operational KPIs.
Partner with analytics to ensure dashboards and reporting tools are accurate and actionable.
Identify opportunities for continuous improvement based on audit results.
Serve as SME during product implementation, ensuring all components are ready for deployment. 🎯 Requirements
5-10+ years of experience in Skilled Nursing Facility clinical operations, utilization management, payment integrity or audit programs.
Strong understanding of CMS SNF regulations, PDPM, MDS/RAI, therapy documentation and medical necessity criteria.
Experience developing or executing clinical audit programs for Medicaid, Medicare and/or commercial payors.
Familiarity with claims data, coding standards and documentation requirements.
Ability to translate complex clinical and regulatory concepts into clear operational and product requirements.
Strong communication, analytical and data comprehension skills.
Preferred Experience RN, PT, OT, SLP or other clinical licensure.
Experience with payment integrity vendors, health plans or state Medicaid agencies.
Background in product development or clinical audit solution design.
Experience developing claims scoring models or working with analytics teams. Apply Now 📊 Check your resume score for this job Improve your chances of getting an interview by checking your resume score before you apply. Check Resume Score Similar Jobs Product Marketing Specialist 🔥 3 hours ago Hewlett Packard Enterprise 10,000+ employees 🏢 Enterprise 🔧 Hardware ☁️ SaaS Website LinkedIn All Job Openings Product Marketing Specialist for HPE Morpheus supporting product lifecycle initiatives across marketing and sales. Collaborating with product management teams to create content and messaging for market success. 🇺🇸 United States – Remote 💵 $66.8k - $126k / year ⏰ Full Time 🟢 Junior 🟡 Mid-level 🪄 Product Specialist 🦅 H1B Visa Sponsor Product Consultant 🔥 4 hours ago BlueCross BlueShield of South Carolina 10,000+ employees ⚕️ Healthcare Insurance 💸 Finance Website LinkedIn All Job Openings Product Consultant managing post-launch product efficacy and vendor collaboration for BlueCross BlueShield. Supports training, customer satisfaction, and external relationships in healthcare. 🇺🇸 United States – Remote ⏰ Full Time 🟡 Mid-level 🟠 Senior 🪄 Product Specialist Product Line Specialist – CF34, AE3007 🔥 6 hours ago Jet Support Services, Inc. (JSSI) 501 - 1000 🚀 Aerospace 💸 Finance 🚗 Transport Website LinkedIn All Job Openings Product Line Specialist managing maintenance events for turbine-powered aircraft at JSSI. Ensuring accurate quotes, cost control, and robust client communication during maintenance operations. 🇺🇸 United States – Remote ⏰ Full Time 🟠 Senior 🔴 Lead 🪄 Product Specialist Market Intelligence & Positioning Specialist, Product Storytelling 🔥 10 hours ago Syndio 51 - 200 🏢 Enterprise 📋 Compliance 💸 Finance Website LinkedIn All Job Openings Market Intelligence & Positioning Specialist owning operational backbone of product marketing at Syndio. Collaborating across sales, product, and marketing to ensure effective and accurate market messaging. 🇺🇸 United States – Remote 💵 $144k - $160k / year ⏰ Full Time 🟡 Mid-level 🟠 Senior 🪄 Product Specialist 🦅 H1B Visa Sponsor Senior Clinical Product Specialist, OR/NICU/PICU – Acute Care and Monitoring 🔥 11 hours ago Medtronic 10,000+ employees ⚕️ Healthcare Insurance Website LinkedIn All Job Openings Clinical Product Specialist in Medtronic focusing on Acute Care and Monitoring products. Engaging with clinical professionals and driving product adoption in the healthcare sector. 🇺🇸 United States – Remote 💵 $110k / year ⏰ Full Time 🟠 Senior 🪄 Product Specialist 🦅 H1B Visa Sponsor View More Product Specialist Jobs 🌐 Worldwide Built by Lior Neu-ner. I'd love to hear your feedback — Get in touch via DM or support@remoterocketship.com Search Search Jobs by country Search jobs by city Search jobs by job title Search entry-level jobs Search junior-level jobs Search senior-level jobs Search jobs by tech stack Search jobs by contract type Search remote internships Search remote part-time jobs Remote jobs Anywhere in the World Companies Hiring Anywhere in the World Companies Hiring Sales People Anywhere in the World Companies Hiring Software Engineers Anywhere in the World Resources Advice Tips for finding remote jobs Interview questions and answers Resume examples Cover letter examples Post a job Affiliates Privacy policy Terms of service Job board SEO course AI Apply Copilot OpenClaw job finder Jobs by Country Remote jobs anywhere in the world (Worldwide remote jobs) Remote jobs United States Remote jobs Australia Remote jobs Brazil Remote jobs Canada Remote jobs France Remote jobs Ireland Remote jobs Germany Remote jobs Netherlands Remote jobs Spain Remote jobs UK Popular Jobs Remote data analyst jobs Remote customer support jobs Remote executive assistant jobs Remote marketing jobs Remote product designer jobs Remote product manager jobs Remote project manager jobs Remote recruiter jobs Remote sales jobs Remote software engineer jobs Jobs by Type Remote full-time jobs Remote part-time jobs Remote contract jobs Remote internship jobs Remote entry-level jobs Remote jobs with no experience required Remote junior jobs (1-3 years of experience) Digital nomad jobs Remote jobs with no degree required Freelance remote jobs Temporary remote jobs Remote jobs hiring now Stay at home mom jobs

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Hard Skills & Tools

SNF audit methodologymedical necessity criteriadocumentation standardscoding requirementsclaims scoring modelsclinical audit programsclaims dataregulatory updatesend-to-end workflowsreporting tools

Soft Skills

communication skillsanalytical skillsdata comprehensioncontinuous improvementtraining supportoperational process translationstakeholder engagementproblem-solvingcollaborationproject management

Certifications

RNPTOTSLPclinical licensure