Director of Payment Integrity

Job Summary

To enhance carrier partnerships and operational excellence, the full-time Director of Payment Integrity will oversee payment operations, quality assurance, and analytics while engaging with clients and carriers in a remote environment.

Key responsibilities

• Attend monthly Business Review and Carrier meetings to provide analytical insights and lead data-driven discussions
• Manage escalations and ensure timely resolution of carrier issues while championing a high-quality experience across all touchpoints
• Identify performance gaps and lead cross-functional improvement initiatives to strengthen trust and transparency with carriers

Required qualifications

• Bachelor's degree in business, operations, or related field; advanced degree preferred
• 5 - 10+ years of experience in payment integrity operations, clinical coding, or account management
• Experience managing payment integrity operations processes and complex operational programs
• Strong data analytics skills and proficiency in data visualization tools
• Proven ability in relationship building and process improvement