VP, Payment Integrity

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

📋 Description

• Oversee the comprehensive payment integrity business strategy, operational model, and execution roadmap throughout the HealthEdge ecosystem.

• Responsible for portfolio performance, business expansion, and the attainment of financial goals related to payment integrity solutions.

• Develop and implement a long-term vision and transformation roadmap for payment integrity capabilities across the HealthEdge platform.

• Propel innovation strategies by utilizing AI, analytics, automation, and cutting-edge healthcare technologies.

• Lead the creation of business cases and investment strategies for new capabilities, partnerships, and market opportunities.

• Set payment integrity roadmap priorities that align with product, technology, and market strategies.

• Implement executive-level client engagement strategies to enhance the adoption, retention, and expansion of payment integrity solutions.

• Cultivate and sustain strategic relationships with executive stakeholders across payer organizations and industry partners.

• Define clear operating rhythms, performance expectations, and accountability within the team.

• Advance the enterprise analytics strategy and foster insight-driven innovation for payment integrity capabilities in collaboration with Data teams.

• Collaborate with Data and Analytics teams to ensure precision, consistency, and rigor in payment integrity outputs.

• Establish governance frameworks, executive reporting structures, and performance metrics to assess business impact and operational efficiency.

• Advocate for payment integrity priorities and business performance in executive leadership forums.

⛳️ Requirements

• Bachelor's degree is mandatory.

• An advanced degree (MBA, MHA, MPH) is preferred.

• 10–15+ years of experience in healthcare, payment integrity, claims operations, or a related field.

• Minimum of 7 years in senior leadership roles.

• Experience within healthcare technology, payer organizations, or related service environments.

• Extensive knowledge of payment integrity methodologies, including claims editing, payment policy, and cost containment strategies.

• A strong understanding of healthcare reimbursement models, payer operations, and regulatory aspects.

• Experience with healthcare data, analytics, and technology-enabled solutions.

• Familiarity with CMS guidelines and broader regulatory frameworks is preferred.

• Proven success in leading enterprise-scale healthcare or payment integrity transformation initiatives.

• Demonstrated capability to influence executive stakeholders, enterprise strategy, and investment prioritization decisions.

• Experience managing business outcomes, growth strategies, and operational performance in complex matrixed organizations.

• Acknowledged industry leader with experience representing organizations externally through conferences, advisory boards, publications, or analyst engagements.

• Proven experience leading through organizational scale, transformation, and change management initiatives.

• Excellent communication and presentation skills for both technical and non-technical audiences.

• Ability to build credibility with internal stakeholders and clients.

• Proficient in navigating complex environments and driving alignment across teams.

🏝️ Benefits

• HealthEdge is an equal opportunity employer.

• Committed to fostering workforce diversity.

• Actively encourage all qualified individuals to pursue employment with us.