Quality & Revenue Integrity Manager (Remote)

We are seeking a Quality & Revenue Integrity Manager to support the integrity, accuracy, and compliance of medical coding and claims practices across the revenue cycle. This individual will serve as a subject matter expert in claims and coding quality, with deep knowledge of reimbursement guidelines, code sets, and regulatory requirements tied to facility and/or professional billing. This person will play a critical role in protecting revenue by ensuring coding work is audit-ready, compliant, and aligned with payer, Medicare, Medicaid, AMA, and state-specific guidelines. This role will also provide education and guidance to coding teams, proactively identify coding changes, and develop internal reference tools and best practices to strengthen coding quality and reduce organizational exposure.

This person will be responsible for reviewing coding and claims work to ensure accuracy, compliance, and alignment with all applicable billing and reimbursement guidelines. On a daily basis, they will audit cases, validate coding selections, and confirm that claims are supported by the appropriate diagnosis codes, modifiers, PCS codes, revenue codes, and payer-specific requirements. They will serve as a key quality checkpoint within the revenue cycle, ensuring that completed coding work is correct, defensible, and ready for internal or external audit with minimal risk of exposure. In addition, this person will research coding updates and regulatory changes, develop reference materials and tools to support the coding team, and provide education and feedback to coders to improve consistency and adherence to standards. While the role is not heavily client-facing, it requires strong analytical and research skills, sound judgment, and the ability to operate proactively to protect both coding quality and overall revenue integrity.

We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.

Minimum 8+ years of experience in medical coding, revenue integrity, coding quality, or healthcare revenue cycle operations
Expert-level knowledge of correct claims billing, including facility, professional, or combined claims
Strong understanding of revenue codes, claim forms, and coding code sets including:

Diagnosis coding
Modifiers
PCS codes
Other applicable billing/coding components


Proven experience auditing coding and claims to determine whether coding is accurate, compliant, and properly supported
Deep knowledge of applicable coding and billing resources and regulations, including: AMA guidelines, Medicare, Medicaid/state guidelines, Payer-specific requirements, etc.
Experience reviewing cases, conducting audits, and validating coding quality prior to external review or audit activity
Ability to educate and mentor coders on coding updates, findings, best practices, and compliance expectations
Strong understanding of the back-end / behind-the-scenes side of medical coding, with a focus on quality assurance and revenue protection
Experience proactively identifying coding and regulatory changes and ensuring coding teams are applying updates correctly
Ability to ensure completed work is accurate, compliant, and audit-ready to minimize risk and revenue exposure

Experience working within large, highly regarded healthcare systems such as Mayo Clinic, Cleveland Clinic, or similar complex provider organizations
Advanced clinical or academic credentials, including a doctorate
Leadership experience at the manager or director level

Benefit packages for this role will start on the 1st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.