Senior Manager, Program Integrity (CPC, RHIT or RHIA is required)

Senior Manager, Program Integrity

This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Senior Manager, Program Integrity (CPC, RHIT or RHIA required) in United States.

As a Senior Manager, Program Integrity, you will lead initiatives to ensure compliance, accuracy, and quality in medical record auditing and reimbursement processes. This role requires both strategic oversight and hands-on expertise, balancing leadership of auditing teams with active involvement in regulatory compliance, fraud prevention, and system optimization. You will collaborate closely with medical directors, clinical staff, and technology partners to implement effective auditing procedures, ensure appropriate reimbursements, and minimize risks of fraud, waste, and abuse. This is a highly visible leadership opportunity for someone with deep coding knowledge, regulatory awareness, and proven management experience.

Accountabilities

Lead and oversee medical record coding auditors, ensuring quality, compliance, and timely delivery of audits.

Implement and optimize auditing procedures, including prepay and post-pay reviews, to improve efficiency and accuracy.

Oversee regulatory documentation, maintain current standards, and ensure compliance with industry requirements.

Collaborate with clinical and medical teams to review coding guidelines, reimbursement policies, and code edits.

Direct new product and vendor implementations, ensuring smooth and timely rollouts.

Manage system configuration, ticket controls, and change management processes.

Provide expertise in coding, reimbursement methodologies (APC, DRG, OPPS), and predictive analytics modeling.

Monitor departmental budgets, track savings, and report on quality and financial outcomes.

Stay updated on evolving regulations, coding standards, and compliance requirements through research, training, and professional development.

Recruit, mentor, and manage staff, fostering a high-performance culture.