Director,PaymentIntegrity

## Accountabilities Serve as the primary subject matter expert for payment integrity initiatives, providing clinical, coding, and technical guidance to leadership and cross-functional stakeholders. Support provider-facing teams in resolving complex escalations and payment disputes through evidence-based analysis and transparent communication. Conduct root cause investigations to identify trends, improve audit logic, and enhance payment accuracy across the organization. Provide clinical and coding expertise to audit and dispute resolution teams, ensuring consistency with contractual obligations and industry standards. Develop internal best-practice resources, educational materials, and payment integrity documentation to strengthen organizational knowledge. Collaborate with compliance, network, and operational teams to align payment policies, contract language, and regulatory requirements. Advocate for process improvements, technology adoption, and innovative approaches to enhance payment integrity outcomes and operational efficiency. Requirements Active Registered Nurse (RN) license and/or Certified Professional Coder (CPC/CPMA) credential required. 8+ years of experience in healthcare payment integrity, medical auditing, revenue cycle management, or related leadership roles. Strong expertise in clinical coding, payment policy interpretation, claims auditing, and healthcare reimbursement processes. Demonstrated ability to communicate complex clinical and coding concepts to executive stakeholders and diverse audiences. Proven experience managing high-priority escalations and resolving technical disputes with providers. Previous leadership experience with a track record of mentoring teams and driving successful program outcomes. Comfort working with emerging technologies and a willingness to embrace AI-driven tools and workflows. Strong analytical thinking, problem-solving skills, and the ability to thrive in dynamic, fast-paced environments. Experience with automation