AVP Payment Integrity Strategy

Job Summary

A company is looking for an AVP Program Integrity - Ideation and Analytics.

Key Responsibilities

• Lead multi-disciplinary teams to develop and scale pre-pay and post-pay audit operations
• Interpret complex reimbursement rules and translate regulatory changes into audit strategies
• Oversee vendor relationships and ensure compliance with enterprise Payment Integrity strategy

Required Qualifications

• 10+ years of healthcare experience in Payment Integrity, SIU/FWA, and audit operations
• Strong experience with payer environments (Medicaid, Medicare, Commercial) and audit vendors
• Proven leadership of teams of 20-30+ investigators, SMEs, analysts, and auditors
• Bachelor's degree in Criminal Justice, Finance, Healthcare Administration, or related field
• Certifications such as AHFI and CPC are highly preferred