Payment Integrity Principal

Job Summary

A company is looking for a Payment Integrity Principal to oversee payment integrity strategy and automation across its platform.

Key Responsibilities

• Serve as a senior business owner for implementing program domain logic across the platform
• Ensure cohesive interaction between rule logic, automation, and AI-driven capabilities for scalable outcomes
• Analyze claims data to identify patterns and contribute to the development of payment integrity policies

Required Qualifications

• Bachelor's degree in healthcare, business, information systems, data analytics, or a related field, or equivalent experience
• Active professional credential in Coding Review, Coordination of Benefits, or Data Mining
• 12+ years of experience in healthcare payment integrity or closely related fields
• 7+ years of experience in analyzing or designing solutions for improper payments
• Proven experience in translating domain expertise into scalable logic and automation frameworks