Vice President of Payment Integrity

Job Summary

Leading the enterprise Payment Integrity function, the full-time Vice President of Payment Integrity will develop and execute strategies to enhance payment accuracy and medical cost performance, while managing a combination of internal teams and vendor partnerships in a fully remote environment.

Key responsibilities

• Develop and implement a multi-year Payment Integrity strategy and capability roadmap to enhance payment accuracy and reduce medical costs
• Oversee the Payment Integrity vendor portfolio, including vendor selection, contract negotiation, and performance governance
• Lead the evolution of prepay and postpay programs, ensuring compliance and effective integration into the broader Payment Integrity framework

Required qualifications

• 12+ years of progressive experience in healthcare Payment Integrity or claims operations, with at least 7 years in leadership roles
• Direct experience managing Payment Integrity programs within a health plan (payer) organization
• Proven track record in vendor management, including selection and negotiation of contracts
• Deep understanding of reimbursement methodologies and coding standards, such as MS-DRG and ICD-10
• Bachelor's degree in business, healthcare administration, finance, or a related field