Senior Director of Payment Integrity

Job Summary

A company is looking for a Senior Director, Payment Integrity - Regulatory Oversight.

Key Responsibilities

• Provide strategic leadership for the Regulatory & Compliance Oversight function to ensure compliance and audit readiness
• Lead the development and execution of regulatory alignment strategies for Payment Integrity programs
• Oversee regulatory intelligence activities and manage responses to regulatory inquiries and audits

Required Qualifications

• Bachelor's degree in Healthcare Administration, Nursing, Finance, Accounting, Business, Operations Management, or a related field; Master's degree preferred
• 10+ years of experience in Payment Integrity, regulatory compliance, or managed care operations
• 4+ years of experience with Payment Integrity functions, including audits and policy development
• Experience leading regulatory and compliance functions within a health plan or large managed care organization
• Strong knowledge of Medicaid and Medicare managed care requirements and regulatory expectations preferred