VP, Payment Integrity

🕒 il y a 1 mois

🇺🇸 États-Unis – Télétravail

💵 $240 000 - $265 000 / an

⏰ Temps Plein

🔴 Expert

👔 Vice-président

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HealthEdge

Site WebLinkedInTous les Emplois

1001 - 5000 employés

Fondée en 2005

🏥 Santé

💼 Conseil

⚕️ Assurance santé

Healthcare • Consulting • Healthcare Insurance

HealthEdge est une entreprise spécialisée dans la fourniture de solutions avancées pour les gestionnaires de soins de santé grâce à sa suite HealthRules Solutions. Cette suite comprend un système complet de traitement administratif des réclamations numériques, des solutions de gestion des workflows de soins et des solutions d'intégrité des paiements, visant à améliorer l'efficacité opérationnelle et la qualité des soins pour les régimes de santé. En tirant parti de la technologie intégrée et de l'automatisation, HealthEdge aide les régimes de santé à éliminer les silos de données, à accroître la précision des paiements et à améliorer l'expérience des membres, transformant ainsi le paysage des soins de santé pour une meilleure collaboration et accessibilité.

Description

• 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.

🎯 Exigences

• 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.

🏖️ Avantages

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