VP, Payment Integrity

🕒 June 26

🇺🇸 United States – Remote

💵 $240k - $265k / year

⏰ Full Time

🔴 Lead

👔 Vice President

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HealthEdge

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2005

🏥 Healthcare

💼 Consulting

⚕️ Healthcare Insurance

Healthcare • Consulting • Healthcare Insurance

HealthEdge is a company that specializes in providing advanced solutions for healthcare payers through its HealthRules Solutions Suite. This suite includes a comprehensive digital claims administration processing system, care management workflow solutions, and payment integrity solutions, which aim to enhance operational efficiency and improve quality of care for health plans. By leveraging integrated technology and automation, HealthEdge helps health plans eliminate data silos, increase payment accuracy, and elevate member experience, thereby transforming the healthcare landscape for better collaboration and accessibility.

📋 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.

🎯 Requirements

• 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.

🏖️ Benefits

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