VP, Payment Integrity

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

📋 Description

• Oversee the strategy and execution of payment integrity, encompassing both pre- and post-payment evaluations, as well as initiatives for fraud, waste, and abuse (FWA) prevention and recovery.

• Create and implement solutions to mitigate leakage throughout the claims lifecycle, which involves enhancing internal capabilities and executing programs with external vendors.

• Evaluate the existing payment integrity program ecosystem and identify key opportunities to generate additional savings.

• Build and manage a high-performing portfolio of multiple vendors, ensuring strict adherence to service level agreements (SLAs) and optimizing contingency fee structures to enhance financial outcomes while minimizing provider friction.

• Provide executive leadership for all payment integrity operations, guaranteeing the high performance of both internal and external payment integrity programs.

• Direct the strategy and implementation to in-source payment integrity opportunities when suitable.

• Establish and monitor key performance indicators (KPIs) related to savings and operations.

• Develop, expand, and optimize payment integrity operations to support business growth, new product introductions, and compliance with regulatory requirements.

• Collaborate with Finance and Medical Economics to ensure meticulous tracking of savings from payment integrity initiatives.

• Build, mentor, and lead a high-performing leadership team that fosters a culture of accountability, collaboration, and continuous improvement.

• Create robust leadership and career development pathways within the organization to enhance retention and succession planning.

⛳️ Requirements

• Over 15 years of progressive leadership experience in healthcare claims or payment integrity operations, with substantial executive-level responsibilities.

• Profound knowledge of medical claims operations, payment integrity, claims configuration, and regulatory compliance.

• Demonstrated success in scaling operational organizations within high-growth or intricate environments.

• Strong comprehension of healthcare regulations, audit requirements, and industry best practices.

• Proven ability to lead large, distributed teams and manage complex vendor relationships effectively.

• Strategic thinker with exceptional analytical, financial, and operational insights.

🏝️ Benefits

• Coverage for alternative medicine.

• Flexible paid time off (PTO).

• Up to 16 weeks of paid parental leave.

• Paid holidays.

• A 401k program.

• Transportation benefits.

• Education reimbursement.

• Two days of paid paw-ternity leave.