Vice President, Payment Integrity

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

📋 Description

• Create robust business strategies and operational plans that align with Gainwell’s short-term and long-term goals for the solution offering.

• Oversee payment integrity delivery operations to enhance revenue growth, expand margins, and ensure client satisfaction.

• Inspire and lead team members, develop a high-performing management team, and collaborate across functions with Finance, Account Management, Sales, Engineering, and Implementations.

• Manage both pre-payment and post-payment payment integrity solutions, which include Clinical Claim Reviews, Payment Analytics/Data Mining, FraudCapture, Utilization Review, Long-Term Care, and Credit Balance.

• Develop, oversee, and achieve revenue and expense budget objectives.

• Manage product portfolio development plans alongside technical development partners, ensuring alignment with client requirements and revenue forecasts.

• Monitor systems and processes that identify and mitigate opportunities and risks within the payment integrity revenue portfolio.

• Utilize advanced financial analysis and forecasting methods to project and optimize revenue.

• Collaborate with the VP Product regarding product expansion and annual revenue goals.

• Partner with the AI development team on initiatives aimed at enhancing efficiency, accelerating growth, and expediting go-to-market strategies.

• Represent the organization in pre-sales solutioning efforts and work collaboratively with Gainwell SGMs and HMS SVP Client Management to design solutions.

• Collaborate with clinical operations to manage demand, capacity, and compliance with client SLAs and contractual obligations.

• Supervise RFP and new business proposal reviews to assess strategic fit, implementation, operational, and financial success.

• Enhance product quality through defect identification, root cause analysis, and the management of corrective action projects.

• Improve internal product processes using Lean and AI-driven continuous quality improvement methodologies.

• Manage staffing planning and workforce management tools throughout the delivery team.

• Develop operational metrics that encompass service efficiency, quality, cost per unit, productivity, staffing to demand, appeals, and analytics efficacy.

• Coordinate with the product implementation team on solution architecture and manage end-to-end project management of new implementations.

• Communicate product strategy, financial performance, operational updates, and quality/compliance matters to company leadership.

• Guide delivery teams through consistent communication, recognition, and quarterly Town Hall meetings.

• Direct leadership development and training, including bench strength and succession planning.

• Actively participate in talent and succession management review sessions as a champion of Talent Management.

⛳️ Requirements

• A minimum of fifteen years of progressively responsible experience in product, finance, and/or operational leadership.

• Required experience in the payer side of the healthcare industry.

• Preferred experience with Medicaid.

• At least five years of leadership experience in payment integrity operations is required.

• Familiarity with AI interventions that lead to revenue acceleration and cost reduction is strongly preferred.

• Excellent interpersonal and influence skills to build relationships, facilitate negotiations, and create partnerships with customers and key stakeholders.

• Strong strategic management, product management, planning, operational, and analytical capabilities.

• Proven track record of working within complex organizational structures.

• Willingness to travel based on client, program, and leadership needs, with an anticipated travel requirement of up to 15% annually.

🏝️ Benefits

• Flexible work arrangements.

• Opportunities for learning and career development.

• Access to technical credentials and certifications.

• Generous and flexible vacation policy.

• Educational assistance.

• Comprehensive leadership and technical development academies.

• Employer-matched 401(k) plan.

• Extensive health benefits.

• Travel expense reimbursement (included among Gainwell’s stated benefits).

• Life insurance (included among Gainwell’s stated benefits).