{"schemaVersion":"jobsearcher.job.v1","id":"88abd771c8986dfd8364d099","url":"https://jobsearcher.com/jobs/88abd771c8986dfd8364d099","canonicalUrl":"https://jobsearcher.com/jobs/88abd771c8986dfd8364d099","title":"Manager, Payment Integrity Program Development & Innovation","description":"About Sagility\n\nSagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees across 5 countries.\n\nManager, Payment Integrity Program Development & Innovation is responsible for leading a team of healthcare payment integrity experts focused on developing, implementing, and optimizing complex audit programs that identify and recover healthcare overpayments. This role oversees the creation of audit concepts, claim selection methodologies, and recovery strategies across inpatient, outpatient, professional, specialty, and durable medical equipment (DME) claim types.\nThe Manager serves as a key leader within the Payment Integrity organization, partnering with clinical, operational, analytics, appeals, and client-facing teams to drive innovative audit solutions, maximize recovery opportunities, and ensure program effectiveness. This position plays a critical role in expanding audit capabilities, improving financial outcomes, and delivering exceptional value to clients.\n\nJob title:\n\nManager, Payment Integrity Program Development & Innovation\n\nJob Description:\n\nManager, Payment Integrity Program Development & Innovation is responsible for leading a team of healthcare payment integrity experts focused on developing, implementing, and optimizing complex audit programs that identify and recover healthcare overpayments. This role oversees the creation of audit concepts, claim selection methodologies, and recovery strategies across inpatient, outpatient, professional, specialty, and durable medical equipment (DME) claim types.\nThe Manager serves as a key leader within the Payment Integrity organization, partnering with clinical, operational, analytics, appeals, and client-facing teams to drive innovative audit solutions, maximize recovery opportunities, and ensure program effectiveness. This position plays a critical role in expanding audit capabilities, improving financial outcomes, and delivering exceptional value to clients.\n\nEssential Responsibilities\n\nLeadership & Team Development\n\nLead, mentor, and develop a team of Subject Matter Experts responsible for complex audit program design and implementation.\nFoster a culture of accountability, collaboration, innovation, and continuous improvement.\nEstablish performance expectations and monitor team productivity, quality, and operational effectiveness.\nSupport recruitment, onboarding, professional development, and succession planning initiatives.\n\nAudit Program Development\n\nDevelop and maintain a portfolio of complex payment integrity audit concepts and recovery initiatives.\nIdentify emerging overpayment risks and reimbursement vulnerabilities across multiple healthcare claim types.\nEvaluate opportunities based on financial impact, operational feasibility, recovery potential, and client value.\nCollaborate with internal stakeholders to prioritize and implement new audit programs.\n\nClaim Selection Strategy\n\nPartner with analytics and technology teams to design, validate, and optimize claim selection methodologies and audit algorithms.\nDefine business requirements and selection criteria for complex audit programs.\nMonitor audit performance and continuously refine targeting strategies to improve recovery yield and audit accuracy.\nEvaluate program metrics, including hit rates, recovery rates, overturn rates, and return on investment.\n\nRegulatory & Technical Expertise\n\nProvide subject matter expertise on healthcare reimbursement methodologies, payment policies, coding guidelines, and industry best practices.\nEnsure audit concepts and methodologies comply with applicable regulatory, contractual, and operational requirements.\nServe as an escalation point for complex audit findings, provider disputes, and appeals support activities.\nMaintain current knowledge of Medicare, Medicaid, Commercial, and Managed Care reimbursement methodologies.\n\nClient & Cross-Functional Collaboration\n\nPartner with Operations, Clinical, Appeals, Product, Analytics, Compliance, and Client Services teams to support successful program implementation.\nParticipate in client-facing discussions related to audit methodologies, findings, performance metrics, and program strategy.\nSupport sales, implementation, and proposal efforts by providing subject matter expertise and audit program recommendations.\nContribute to strategic initiatives that enhance payment integrity capabilities and client outcomes.\n\nRequired Qualifications\n\nEducation\n\nBachelor’s degree in Nursing, Health Information Management, Healthcare Administration, Business Administration, Finance, or a related field.\n\nExperience\n\nMinimum of 5 years of healthcare Payment Integrity experience.\nMinimum of 3 years of leadership experience managing audit, coding, clinical, payment integrity, or SME teams.\nDemonstrated experience developing complex healthcare audit concepts and claim selection methodologies.\nStrong knowledge of healthcare reimbursement methodologies, claims adjudication, coding systems, and payment integrity operations.\nExperience collaborating with analytics, operations, and appeals teams to implement audit programs.\n\nPreferred Qualifications\n\nCurrent unrestricted RN license.\nRHIA, RHIT, CCS, CPC, COC, CIC, CRC, or other applicable healthcare industry certification.\nExperience with Medicare, Medicaid, Commercial, and Medicare Advantage reimbursement methodologies.\nExperience supporting client implementations, provider engagement activities, and RFP responses.\nExperience with healthcare data analysis, audit technology platforms, and complex claims analytics.\n\nKnowledge, Skills & Abilities\n\nHealthcare Reimbursement Methodologies\nPayment Integrity Program Management\nComplex Audit Concept Development\nClaims Analytics and Audit Selection Strategies\nRegulatory Compliance and Healthcare Policy Knowledge\nLeadership and Team Development\nStrategic Planning and Problem Solving\nProject and Portfolio Management\nStrong Written and Verbal Communication Skills\nClient Relationship Management\nProcess Improvement and Operational Excellence\n\nSuccess Measures\n\nSuccess in this role will be measured by:\n\nDevelopment and implementation of new audit concepts\nRecovery yield and financial performance of audit programs\nImprovement in audit hit rates and return on investment\nTeam productivity, quality, and engagement\nClient satisfaction and retention\nRegulatory compliance and audit defensibility\nInnovation and continuous improvement outcomes\n\nSagility is an Equal Opportunity Employer/Vet/Disability\n\nLocation:\n\nWork@Home USAUnited States of America","company":"Sagility","rawCompany":"sagility","city":"Myrtle Point","state":"OR","isRemote":false,"isActive":false,"createdAt":"2026-09-28T11:45:33.845Z","occupations":[{"code":"11-9111.00","title":"Medical and Health Services Managers","slug":"medical-and-health-services-managers"},{"code":"11-9199.02","title":"Compliance Managers","slug":"compliance-managers"},{"code":"11-3021.00","title":"Computer and Information Systems Managers","slug":"computer-and-information-systems-managers"}],"industries":[{"code":"524292","title":"Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds","slug":"pharmacy-benefit-management-and-other-third-party-administration-of-insurance-and-pension-funds"},{"code":"524298","title":"All Other Insurance Related Activities","slug":"all-other-insurance-related-activities"},{"code":"541618","title":"Other Management Consulting Services","slug":"other-management-consulting-services"}],"jobPosting":{"@context":"https://schema.org","@type":"JobPosting","title":"Manager, Payment Integrity Program Development & Innovation","description":"About Sagility\n\nSagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees across 5 countries.\n\nManager, Payment Integrity Program Development & Innovation is responsible for leading a team of healthcare payment integrity experts focused on developing, implementing, and optimizing complex audit programs that identify and recover healthcare overpayments. This role oversees the creation of audit concepts, claim selection methodologies, and recovery strategies across inpatient, outpatient, professional, specialty, and durable medical equipment (DME) claim types.\nThe Manager serves as a key leader within the Payment Integrity organization, partnering with clinical, operational, analytics, appeals, and client-facing teams to drive innovative audit solutions, maximize recovery opportunities, and ensure program effectiveness. This position plays a critical role in expanding audit capabilities, improving financial outcomes, and delivering exceptional value to clients.\n\nJob title:\n\nManager, Payment Integrity Program Development & Innovation\n\nJob Description:\n\nManager, Payment Integrity Program Development & Innovation is responsible for leading a team of healthcare payment integrity experts focused on developing, implementing, and optimizing complex audit programs that identify and recover healthcare overpayments. This role oversees the creation of audit concepts, claim selection methodologies, and recovery strategies across inpatient, outpatient, professional, specialty, and durable medical equipment (DME) claim types.\nThe Manager serves as a key leader within the Payment Integrity organization, partnering with clinical, operational, analytics, appeals, and client-facing teams to drive innovative audit solutions, maximize recovery opportunities, and ensure program effectiveness. This position plays a critical role in expanding audit capabilities, improving financial outcomes, and delivering exceptional value to clients.\n\nEssential Responsibilities\n\nLeadership & Team Development\n\nLead, mentor, and develop a team of Subject Matter Experts responsible for complex audit program design and implementation.\nFoster a culture of accountability, collaboration, innovation, and continuous improvement.\nEstablish performance expectations and monitor team productivity, quality, and operational effectiveness.\nSupport recruitment, onboarding, professional development, and succession planning initiatives.\n\nAudit Program Development\n\nDevelop and maintain a portfolio of complex payment integrity audit concepts and recovery initiatives.\nIdentify emerging overpayment risks and reimbursement vulnerabilities across multiple healthcare claim types.\nEvaluate opportunities based on financial impact, operational feasibility, recovery potential, and client value.\nCollaborate with internal stakeholders to prioritize and implement new audit programs.\n\nClaim Selection Strategy\n\nPartner with analytics and technology teams to design, validate, and optimize claim selection methodologies and audit algorithms.\nDefine business requirements and selection criteria for complex audit programs.\nMonitor audit performance and continuously refine targeting strategies to improve recovery yield and audit accuracy.\nEvaluate program metrics, including hit rates, recovery rates, overturn rates, and return on investment.\n\nRegulatory & Technical Expertise\n\nProvide subject matter expertise on healthcare reimbursement methodologies, payment policies, coding guidelines, and industry best practices.\nEnsure audit concepts and methodologies comply with applicable regulatory, contractual, and operational requirements.\nServe as an escalation point for complex audit findings, provider disputes, and appeals support activities.\nMaintain current knowledge of Medicare, Medicaid, Commercial, and Managed Care reimbursement methodologies.\n\nClient & Cross-Functional Collaboration\n\nPartner with Operations, Clinical, Appeals, Product, Analytics, Compliance, and Client Services teams to support successful program implementation.\nParticipate in client-facing discussions related to audit methodologies, findings, performance metrics, and program strategy.\nSupport sales, implementation, and proposal efforts by providing subject matter expertise and audit program recommendations.\nContribute to strategic initiatives that enhance payment integrity capabilities and client outcomes.\n\nRequired Qualifications\n\nEducation\n\nBachelor’s degree in Nursing, Health Information Management, Healthcare Administration, Business Administration, Finance, or a related field.\n\nExperience\n\nMinimum of 5 years of healthcare Payment Integrity experience.\nMinimum of 3 years of leadership experience managing audit, coding, clinical, payment integrity, or SME teams.\nDemonstrated experience developing complex healthcare audit concepts and claim selection methodologies.\nStrong knowledge of healthcare reimbursement methodologies, claims adjudication, coding systems, and payment integrity operations.\nExperience collaborating with analytics, operations, and appeals teams to implement audit programs.\n\nPreferred Qualifications\n\nCurrent unrestricted RN license.\nRHIA, RHIT, CCS, CPC, COC, CIC, CRC, or other applicable healthcare industry certification.\nExperience with Medicare, Medicaid, Commercial, and Medicare Advantage reimbursement methodologies.\nExperience supporting client implementations, provider engagement activities, and RFP responses.\nExperience with healthcare data analysis, audit technology platforms, and complex claims analytics.\n\nKnowledge, Skills & Abilities\n\nHealthcare Reimbursement Methodologies\nPayment Integrity Program Management\nComplex Audit Concept Development\nClaims Analytics and Audit Selection Strategies\nRegulatory Compliance and Healthcare Policy Knowledge\nLeadership and Team Development\nStrategic Planning and Problem Solving\nProject and Portfolio Management\nStrong Written and Verbal Communication Skills\nClient Relationship Management\nProcess Improvement and Operational Excellence\n\nSuccess Measures\n\nSuccess in this role will be measured by:\n\nDevelopment and implementation of new audit concepts\nRecovery yield and financial performance of audit programs\nImprovement in audit hit rates and return on investment\nTeam productivity, quality, and engagement\nClient satisfaction and retention\nRegulatory compliance and audit defensibility\nInnovation and continuous improvement outcomes\n\nSagility is an Equal Opportunity Employer/Vet/Disability\n\nLocation:\n\nWork@Home USAUnited States of America","datePosted":"2026-09-28T11:45:33.845Z","dateModified":"2026-09-28T11:45:33.845Z","hiringOrganization":{"@type":"Organization","name":"Sagility","sameAs":"https://jobsearcher.com"},"jobLocation":{"@type":"Place","address":{"@type":"PostalAddress","addressLocality":"Myrtle Point","addressRegion":"OR","addressCountry":"US"}},"identifier":{"@type":"PropertyValue","name":"JobSearcher","value":"88abd771c8986dfd8364d099"},"url":"https://jobsearcher.com/jobs/88abd771c8986dfd8364d099"}}