Director of Payment Integrity, Hospital & Ancillary Performance

Solis Health Plans

7h•Onsite

About The Position

The Director of Payment Integrity, Hospital & Ancillary Performance is responsible for establishing and maintaining a structured, data-driven framework for financial oversight, vendor performance monitoring, and payment integrity across ancillary providers, delegated entities (FDRs), and hospital partners. This role emphasizes analytics, reconciliation controls, proactive identification of financial and operational risk, and cross-functional accountability. The position represents a shift from historic relationship-based vendor management to a disciplined, performance-driven model focused on financial integrity, contract optimization, and enterprise-wide oversight as the company has evolved and grown rapidly.

Requirements

Bachelor’s degree in Finance, Economics, Business, or related field
8–10+ years of experience in healthcare operations, financial analysis, payment integrity, or vendor oversight
Demonstrated experience in financial analysis, reporting, and performance monitoring
Strong understanding of healthcare vendors and/or hospital operations

Nice To Haves

MBA or advanced degree
Experience in Medicare Advantage or Managed Care
Experience developing dashboards and reporting frameworks (e.g., Power BI or similar tools)
Experience with contract performance evaluation and cost optimization

Responsibilities

Develop and maintain invoice validation and reconciliation processes across all ancillary vendors, FDRs, and hospital partners
Monitor PMPM trends, financial variances, and invoice sufficiency
Identify and escalate discrepancies, overpayments, and financial risk indicators
Ensure alignment between invoices, encounter data, and contractual terms
Design and implement a comprehensive dashboard suite for vendors, FDR, and hospital performance
Establish KPIs, SLAs, and performance metrics across all partners
Monitor trends and proactively identify performance issues requiring intervention
Support executive and Board-level reporting
Establish structured re-contracting strategies across ancillary vendors, FDRs, and hospital partners
Ensure proper cadence of re-contacting and re-negotiation activities
Evaluate contractual performance against cost, utilization, and service benchmarks
Identify limitations within existing agreements and recommend improvements
Support leadership in improving financial outcomes through contract optimization
Implement structured performance monitoring across delegated vendors
Track compliance, CAPs, SLA adherence, and audit outcomes
Drive accountability through data-driven insights
Coordinate with Compliance and Delegation Oversight functions
Monitor hospital financial and operational performance
Identify contractual exposure points and performance risks
Support leadership in evaluating utilization, cost trends, and contract effectiveness
Align hospital oversight with broader payment integrity strategy
Establish and maintain formal Joint Operating Committees (JOCs) across hospital and FDR/vendor relationships
Ensure consistent cadence of meetings and structured agendas
Drive cross-functional participation (Finance, IT, Provider Network, Compliance, Operations)
Track action items and ensure accountability and follow-through
Partner with Finance, Compliance, Operations, IT, and Network teams
Ensure alignment across reporting systems and data sources
Support enterprise-wide payment integrity initiatives
Lead initiatives to improve financial controls, reporting capabilities, and operational processes
Implement scalable systems to replace manual tracking methods
Drive continuous improvement across oversight and performance frameworks
May supervise analysts, coordinators, or managers as the function expands
Provides leadership, direction, and performance oversight for assigned staff
Responsible for setting priorities, monitoring performance, and ensuring accountability