Payment Integrity Program Development Senior Manager – Clinical & Facility Specialist

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Payment Integrity Program Development Senior Manager – Clinical & Facility Specialist based in the United States. This is a high-impact, highly autonomous role focused on developing innovative payment integrity strategies across the healthcare claims ecosystem. You will serve as a clinical and coding subject-matter expert, identifying payment anomalies and transforming complex clinical and regulatory insights into automated claim-edit solutions. The role spans inpatient, outpatient, ambulatory surgical center, and professional billing environments, with a particular emphasis on complex and high-value care. You will combine clinical research, healthcare policy expertise, coding knowledge, and data analysis to create new concepts from the ground up. Working closely with clinical, claims, legal, and investigative teams, you will influence policy and drive concepts through implementation and optimization. Modern AI tools can support data analysis and research, creating an environment that values both deep expertise and innovative technology.