Vice President, Clearinghouse & Payer Operations

This is a fully remote position, open to applicants in United States.

📋 Description

• Develop and implement the strategy for clearinghouse and payer operations in line with Experian Health’s objectives for growth, margin enhancement, and platform modernization.

• Convert enterprise strategy into scalable operational frameworks, key performance indicators (KPIs), and service-level agreements for payer-facing clearinghouses.

• Spearhead transformation projects centered around automation, AI-driven operations, and modernization efforts.

• Manage the overall operational performance of Experian Health’s real-time and batch clearinghouses.

• Guarantee high availability, throughput, accuracy, and adherence to service level agreements across various transaction types.

• Supervise payer contracting, onboarding, connectivity, testing, certification, and ongoing operational performance.

• Ensure compliance with HIPAA, X12, CMS, FHIR, and other state regulations, as well as payer contractual obligations.

• Collaborate with Product Management and Engineering teams to ensure operational capabilities align with Experian Health’s product roadmap.

⛳️ Requirements

• Over 15 years of relevant leadership experience in healthcare operations, clearinghouse services, payer operations, revenue cycle technology/services, or health IT.

• Proven experience in managing large-scale, high-volume transaction processing organizations.

• Extensive knowledge of healthcare EDI standards and transactions (837, 835, 270/271, 276/277, 278).

• Familiarity with EPIC, Oracle, and Meditech registration workflows.

• Strong grasp of payer-provider workflows and reimbursement procedures.

• Demonstrated capability to lead cross-functional teams in complex, regulated environments.

• Preferred experience in operational transformation, automation, or AI-enabled healthcare operations.

🏝️ Benefits

• Flexible time off, which includes unlimited vacation, volunteer time off, and 12 paid holidays.

• Comprehensive core benefits, including medical, dental, vision, and a matching 401K plan.