VP, Payment Integrity

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

📋 Description

• Spearhead the strategy and implementation of payment integrity, encompassing pre- and post-payment examinations, as well as initiatives to prevent and recover from fraud, waste, and abuse (FWA).

• Develop and manage solutions to minimize leakage throughout the claims process, which includes enhancing internal capabilities and executing external vendor programs.

• Evaluate the existing payment integrity program landscape and identify priority areas for additional savings.

• Construct and oversee a high-performing multi-vendor portfolio, ensuring adherence to strict service level agreements (SLAs) and optimizing contingency fee arrangements to maximize financial returns while reducing provider friction.

• Provide executive oversight for all payment integrity operations, guaranteeing exceptional performance across all internal and external payment integrity programs.

• Drive strategy and execution for insourcing payment integrity opportunities when suitable.

• Establish and track savings and operational key performance indicators (KPIs).

• Develop, expand, and enhance payment integrity operations to support business growth, introduce new products, and comply with regulatory requirements.

• Collaborate with Finance and Medical Economics to ensure precise 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 enhancement.

• Create robust leadership and career advancement pathways within the organization to aid in retention and succession planning.

⛳️ Requirements

• Over 15 years of progressive leadership experience in healthcare claims or payment integrity operations.

• Extensive knowledge in medical claims operations, payment integrity, claims configuration, and compliance with regulations.

• Proven track record of scaling operational organizations in fast-paced or intricate environments.

• Profound understanding of healthcare regulations, auditing standards, and industry best practices.

• Demonstrated capability to lead large, dispersed teams and manage complex relationships with vendors.

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

🏝️ Benefits

• Health insurance

• 401k program

• Flexible PTO

• Up to 16 weeks paid parental leave

• Paid holidays

• Cell phone reimbursement

• Transportation perks

• Education reimbursement

• 1 week of paid paw-ternity leave