ZipRecruiter

Log In

1

Payment Integrity Program Manager Jobs in Pennsylvania

1 Alpha Consulting LLC

Program Manager

Harrisburg, PA · Hybrid

$60K - $70K/yr

... integrity and measurable results. Every project is guided by our core values; reliability ... Coordinating subcontractor/vendor payments with accounting * Supporting invoicing of Pennie and ...

1 Alpha Consulting LLC

Program Manager

Harrisburg, PA · Hybrid

$60K - $70K/yr

... integrity and measurable results. Every project is guided by our core values; reliability ... Coordinating subcontractor/vendor payments with accounting * Supporting invoicing of Pennie and ...

410 ICR United States USA

Program Manager

United, PA · On-site

Program Manager - Global Experience ICON is a global healthcare intelligence and clinical research ... As a values-driven organisation, integrity, collaboration, agility, and inclusion are at the heart ...

Precision Custom Components, LLC

Program Manager

York, PA · On-site

$80K - $100K/yr

Precision Custom Components (PCC) is seeking a talented Program Manager to join our team. This is ... integrity within the workplace. Education/Qualifications: * Bachelor's degree in an engineering ...

Precision Custom Components, LLC

Program Manager

York, PA · On-site

$80K - $100K/yr

Precision Custom Components (PCC) is seeking a talented Program Manager to join our team. This is ... integrity within the workplace. Education/Qualifications: * Bachelor's degree in an engineering ...

Ama-Support-Services

$90 - $120/hr

Program Director The primary responsibility of the Program Manager is to create and perpetuate a culture of excellence, compassion and integrity in the delivery of service to our participants

New

Zurn Elkay Water Solutions

Program Manager

Erie, PA · On-site

Program Manager The Company Zurn Elkay Water Solutions Corporation is a thriving, values-driven ... ZWS), with an enduring reputation for integrity, giving back, and providing an engaging, inclusive ...

Graham Packaging Company

Program Manager

Lancaster, PA · On-site

And we actively promote cooperation, collaboration, integrity and respect across regions and teams ... Graham Packaging is seeking a Program Manager that will direct, coordinate, and exercise functional ...

Teledyne

Program Manager

Montgomeryville, PA · On-site

The Program Manager leads cross-functional program teams, manages project financial performance ... Our reputation for honesty, integrity and high ethics is as important to us as our reputation for ...

Teledyne FLIR LLC

Program Manager

Montgomeryville, PA · On-site

The Program Manager leads cross-functional program teams, manages project financial performance ... Our reputation for honesty, integrity and high ethics is as important to us as our reputation for ...

Graham Packaging Company

Program Manager

Lancaster, PA · On-site

And we actively promote cooperation, collaboration, integrity and respect across regions and teams ... Overview Graham Packaging is seeking a Program Manager that will direct, coordinate, and exercise ...

FLIR Systems, Inc.

Program Manager

Montgomeryville, PA · On-site

$110 - $150/hr

The Program Manager leads cross-functional program teams, manages project financial performance ... Our reputation for honesty, integrity and high ethics is as important to us as our reputation for ...

New

next page

Showing results 1-20

All JobsPayment Integrity Program JobsPayment Integrity Program Manager JobsPayment Integrity Program Manager Jobs in Pennsylvania

Payment Integrity Program Manager information

What is the difference between Payment Integrity Program Manager vs Payment Recovery Specialist?

AspectPayment Integrity Program ManagerPayment Recovery Specialist
CredentialsTypically requires a bachelor’s degree in healthcare, finance, or related fields; certifications like CPC or CPAT are commonOften requires similar healthcare or finance background; certifications like CPC or CPT may be preferred
Work EnvironmentWorks within healthcare organizations or insurance companies, focusing on program oversight and complianceOperates in claims departments or recovery units, focusing on identifying and recovering overpayments
Employer & IndustryHealthcare payers, insurance companies, government programsInsurance companies, healthcare providers, third-party recovery firms

The Payment Integrity Program Manager oversees programs to prevent improper payments, ensuring compliance and efficiency. In contrast, the Payment Recovery Specialist focuses on identifying and recovering overpaid claims. While both roles require healthcare and finance knowledge, the Program Manager has broader responsibilities related to program management, whereas the Recovery Specialist concentrates on claims recovery activities.

What are popular job titles related to Payment Integrity Program Manager jobs in Pennsylvania?

For Payment Integrity Program Manager jobs in Pennsylvania, the most frequently searched job titles are:

What job categories do people searching Payment Integrity Program Manager jobs in Pennsylvania look for?

The top searched job categories for Payment Integrity Program Manager jobs in Pennsylvania are:

What cities in Pennsylvania are hiring for Payment Integrity Program Manager jobs?

Cities in Pennsylvania with the most Payment Integrity Program Manager job openings:

Payment Integrity Program Manager jobs near you
Infographic showing various Payment Integrity Program Manager job openings in Pennsylvania as of August 2026, with employment types broken down into 94% Full Time, and 6% Part Time. Highlights an 68% In-person, 9% Hybrid, and 23% Remote job distribution.

Medical Director, Payment Integrity - Remote (PA/NJ/DE)

Independence Blue Cross

Philadelphia, PA • On-site, Remote

Full-time

Posted 7 days ago

Independence Blue Cross rating

8.8

Company rating: 8.8 out of 10

Based on 26 frontline employees who took The Breakroom Quiz

57th of 315 rated insurance

Job description

The Medical Director, Clinical Payment Integrity provides clinical oversight of payment integrity programs, reimbursement policy interpretation, provider engagement, and payment accuracy initiatives. This role serves as the clinical bridge between the health plan, providers, and internal stakeholders, ensuring payment integrity activities are clinically sound, operationally effective, and aligned with contractual and regulatory requirements.
Partners closely with Utilization Management, Quality, Network Management, Payment Integrity, Informatics, Legal, and Compliance teams to advance payment accuracy, affordability, provider collaboration, and healthcare quality.
This is an opportunity to help establish and expand a growing Clinical Payment Integrity function, influencing future strategy, governance, program development, and provider engagement capabilities.
Key Responsibilities
Clinical Payment Integrity Oversight & Reviews
  • Conduct physician-level clinical reviews and render medical determinations for post-service payment reviews, clinical validation audits, appeals, disputes, and escalated reimbursement matters.
  • Interpret clinical documentation, claims data, coding practices, and reimbursement policies to determine alignment with clinical findings and payment guidelines.
  • Support development of payment integrity policies, audit methodologies, clinical review processes, and reimbursement strategies.
  • Partner with analytics, operations, payment integrity, and policy teams to identify trends, improve review accuracy, and strengthen programs.
  • Serve as the physician escalation point for complex clinical payment integrity cases requiring medical judgment and interpretation.
  • Support efforts to prevent fraud, waste, and abuse while ensuring fair and accurate reimbursement practices.

Provider Engagement & Partnership
  • Serve as a senior clinical liaison to provider organizations, fostering relationships with physicians, revenue cycle leaders, coding teams, and healthcare executives.
  • Lead provider discussions regarding payment policies, audit methodologies, coding interpretations, reimbursement decisions, and review findings.
  • Partner with providers to resolve recurring billing, coding, documentation, and reimbursement issues through education and collaboration.
  • Represent the organization in executive-level meetings, Joint Value Committees (JVCs), Joint Operating Committees (JOCs), and other provider forums to discuss payment accuracy, utilization trends, quality outcomes, claim reviews, disputes, appeals, and improvement opportunities.
  • Act as the physician escalation point for provider concerns, balancing clinical appropriateness, coding standards, contractual requirements, reimbursement policy, and provider perspectives.
  • Solicit provider feedback and incorporate insights into education and operational improvement efforts.

Clinical Leadership, Strategy & Cross-Functional Collaboration
  • Collaborate with Utilization Management Medical Directors, Quality Clinical Leaders, Network Management, Provider Relations, Analytics, Legal, Compliance, and Operational teams to align payment integrity activities, reimbursement policies, medical necessity determinations, and provider communications.
  • Ensure provider perspectives and clinical workflows inform payment integrity initiatives, reimbursement policies, and review processes.
  • Serve as a clinical leader in the development and governance of payment integrity policies, audit methodologies, reimbursement strategies, and clinical review frameworks.
  • Lead root-cause analyses of audit findings, provider disputes, and payment integrity trends to improve processes and payment accuracy.
  • Develop clinical guidance, best practices, and educational resources for internal teams.
  • Coach and mentor clinical reviewers, nurses, coding specialists, and other payment integrity professionals.
  • Partner with organizational leaders to shape and expand the Clinical Payment Integrity function, including its strategy, governance, operating model, review methodologies, and physician review capabilities.
  • Champion solutions that improve payment accuracy, operational effectiveness, provider experience, affordability, and healthcare value.

Required Qualifications
  • Active, unrestricted physician license and current board certification.
  • Minimum seven (7) years of clinical practice experience.
  • Experience in managed care, utilization management, payment integrity, revenue cycle management, health plan operations, clinical auditing, or related healthcare leadership functions.
  • Demonstrated experience conducting clinical reviews and rendering medical determinations in support of utilization management, payment integrity, reimbursement review, or clinical audit activities.
  • Strong knowledge of CPT, ICD-10, HCPCS, clinical documentation requirements, and healthcare reimbursement methodologies.
  • Experience interpreting and applying payment policies, clinical guidelines, medical necessity criteria, and regulatory requirements.
  • Experience managing complex provider disputes, appeals, and reimbursement-related escalations.
  • Strong communication and relationship management skills with the ability to effectively engage providers, executives, and cross-functional stakeholders.
  • Ability to work effectively in a dynamic, matrixed healthcare environment.

Preferred Qualifications
  • Experience as a Health Plan Medical Director, Physician Advisor, or comparable physician leadership role.
  • Experience with clinical validation audits, DRG validation, reimbursement policy, payment integrity operations, or healthcare payment review programs.
  • Experience participating in Joint Value Committees (JVCs), provider governance forums, and executive-level provider engagement activities.
  • Knowledge of value-based care, provider economics, quality measurement, healthcare affordability initiatives, and payment integrity strategies.
  • Experience building new programs, leading change initiatives, or establishing clinical governance and review capabilities.

Fully Remote:
This role is designated by Independence as fully remote. The incumbent will not be required to report to one of Independence's physical office locations to perform the work. However, the work must be performed in the Tri-State Area of Delaware, New Jersey, or Pennsylvania.
IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.

What Independence Blue Cross employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply