MedReview Inc. · 2 days ago
Quality Director/Manager - Payment Integrity
United States
Full-time
Remote
Lead/Staff, Director/Executive
5+ years expMedReview Inc. is seeking a Quality Director/Manager to build and oversee the quality and compliance framework for their Payment Integrity operations. This role will involve developing quality assurance programs, managing audit routines, and ensuring compliance with regulatory standards while collaborating with various stakeholders.
Health CareMedicalNon ProfitProfessional Services
Responsibilities
Develop and lead a comprehensive quality assurance and compliance program for PI operations (DRG review, HBA, COB, IBR, data mining, edit engines)
Establish and manage audit routines, quality checks, and error tracking mechanisms
Implement remediation plans to address systemic issues and drive continuous improvement
Ensure compliance with CMS guidelines, NCCI edits, LCD/NCD policies, payer rules, and internal standards
Partner with the Delivery Manager to enforce production discipline and reporting controls
Collaborate with the Business Analyst to document quality workflows, SOPs, and acceptance criteria
Analyze quality metrics and produce dashboards/reports for leadership on accuracy, compliance, and error trends
Serve as the compliance subject matter expert, keeping the team current on regulatory and payer policy updates
Lead training sessions and workshops to improve staff accuracy, compliance, and adherence to standards
Qualification
Required
Bachelor's degree in Healthcare Administration, Nursing, Business, or related field (Master's or compliance certification a plus)
5–7+ years in healthcare quality management, compliance, or payment integrity operations
Experience implementing audit/QA programs, compliance frameworks, and process controls
Strong knowledge of claims processing and PI functions (DRG, HBA, COB, IBR, edit engines)
Strong analytical skills with the ability to identify quality trends and root causes
Excellent organizational and documentation skills
Ability to influence and collaborate across multiple functions
Familiarity with audit tools, data analysis software, and compliance reporting platforms
Preferred
Experience with CMS program audits, RAC/Medicare Advantage compliance, and commercial payer policies
Lean Six Sigma, CHC (Certified in Healthcare Compliance), or equivalent quality/compliance certification
Prior leadership of a quality/compliance team in a payer, SIU/FWA, or PI environment
Company
MedReview Inc.
MedReview is a different type of payment integrity company.
201-500 employees
H1B Sponsorship
MedReview Inc. has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (4)
2024 (1)
2022 (6)
Funding
Current Stage
Growth StageLeadership Team
Spencer Young
Chief Executive Officer
Ripal Patel
Chief Financial Officer
Recent News
2025-11-20
2025-08-29
2025-07-23
Company data provided by crunchbase