VP, Payment Integrity

🕒 Junho 26

🇺🇸 Estados Unidos – Remoto (EUA)

💵 $240.000 - $265.000 / ano

⏰ Tempo Integral

🔴 Especialista

👔 Vice-presidente

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HealthEdge

SiteLinkedInTodas as Vagas

1001 - 5000 funcionários

Fundada em 2005

🏥 Saúde

💼 Consultoria

⚕️ Seguro de Saúde

Healthcare • Consulting • Healthcare Insurance

HealthEdge é uma empresa especializada em oferecer soluções avançadas para operadoras de saúde por meio do seu HealthRules Solutions Suite. Esse conjunto inclui um sistema digital abrangente de administração e processamento de sinistros, soluções de fluxos de trabalho (workflows) para gestão do cuidado e soluções de integridade de pagamentos, com o objetivo de ampliar a eficiência operacional e melhorar a qualidade do cuidado para os planos de saúde. Ao alavancar tecnologia integrada e automação, a HealthEdge ajuda os planos a eliminar silos de dados, aumentar a precisão dos pagamentos e elevar a experiência dos beneficiários, transformando o ecossistema de saúde para maior colaboração e acessibilidade.

Descrição

• Own the end-to-end payment integrity business strategy, operating model, and execution roadmap across the HealthEdge ecosystem • Accountable for portfolio performance, business growth, and achievement of financial objectives associated with payment integrity solutions • Define and execute a multi-year vision and transformation roadmap for payment integrity capabilities across the HealthEdge platform • Drive innovation strategies leveraging AI, analytics, automation, and emerging healthcare technologies • Lead business case development and investment strategies for new capabilities, partnerships, and market opportunities • Establish payment integrity roadmap priorities in alignment with product, technology, and market strategies • Drive executive-level client engagement strategies to accelerate adoption, retention, and expansion of payment integrity solutions • Build and maintain strategic relationships with executive stakeholders across payer organizations and industry partners • Establish clear operating rhythms, performance expectations, and accountability across the team • Drive enterprise analytics strategy and insight-driven innovation for payment integrity capabilities in partnership with Data teams • Partner with Data and Analytics teams to ensure accuracy, consistency, and rigor in payment integrity outputs • Establish governance frameworks, executive reporting structures, and performance metrics to measure business impact and operational effectiveness • Represent payment integrity priorities and business performance within executive leadership forums.

🎯 Requisitos

• Bachelor’s degree required • Advanced degree (MBA, MHA, MPH) preferred • 10–15+ years of experience in healthcare, payment integrity, claims operations, or related field • 7+ years of senior leadership experience • Experience working within healthcare technology, payer organizations, or related services environments • Strong expertise in payment integrity methodologies, including claims editing, payment policy, and cost containment strategies • Solid understanding of healthcare reimbursement models, payer operations, and regulatory considerations • Experience working with healthcare data, analytics, and technology-enabled solutions • Familiarity with CMS guidelines and broader regulatory frameworks preferred • Demonstrated success leading enterprise-scale healthcare or payment integrity transformation initiatives • Proven ability to influence executive stakeholders, enterprise strategy, and investment prioritization decisions • Experience owning business outcomes, growth strategies, and operational performance within complex matrixed organizations • Recognized industry leader with experience representing organizations externally through conferences, advisory boards, publications, or analyst engagements • Experience leading through organizational scale, transformation, and change management initiatives • Strong communication and presentation skills across technical and non-technical audiences • Ability to build credibility with internal stakeholders and clients • Skilled at navigating complex environments and driving alignment across teams.

🏖️ Benefícios

• HealthEdge is an equal opportunity employer • Committed to workforce diversity • Actively encourage all qualified persons to seek employment with us