Director, Payment Integrity Solutions (Implementations)

Alaffia Health•,

10d

About The Position

Alaffia is hiring a Payment Integrity leader to take health plan clients from signed contract through successful go-live. The Director, Payment Integrity Solutions (Implementations) owns client implementations end to end, shapes the configuration of Alaffia’s AI platform and managed services around real payment integrity workflows, and develops a repeatable implementation playbook to support company growth. The role works closely with Operations, Product, Engineering, Clinical teams, and Client Services, while serving as a trusted advisor to client stakeholders throughout onboarding.

Requirements

At least 8 years of experience in healthcare payment integrity at a health plan or payment integrity vendor.
Strong knowledge of claims review, coding validation (DRG and CPT), and how improper payments are identified and recovered.
A proven track record leading complex claims, payment integrity, or healthcare technology implementations from requirements through go-live; health plan implementation experience is strongly valued.
Experience managing executive-level client relationships and communicating clearly through risk, delays, and change.
Strong project and program management skills, including managing multiple concurrent implementations.
Comfort with AI-enabled tools, claims platforms, or automation, and credibility with both payment integrity operators and engineers.
Excellent written and verbal communication skills.
Demonstrated success driving savings, improving accuracy, or scaling payment integrity programs.

Nice To Haves

Experience with agentic AI or transparent clinical AI in healthcare claims.
Background in health plan operations, utilization management, appeals, or SIU.
Experience building an implementation function or playbook at a growth-stage company.
Familiarity with CMS and state or federal compliance, and common payment integrity issues such as upcoding, unbundling, and coordination of benefits.

Responsibilities

Lead client implementations from kickoff through go-live and stabilization, including scoping, requirements gathering, workflow configuration, testing, and launch.
Translate client payment integrity programs—including pre-pay, post-pay, clinical editing, DRG validation, and overpayment recovery—into effective configurations of Alaffia’s platform.
Build and refine implementation playbooks, templates, and best practices, especially for health plan environments.
Serve as the senior client contact during onboarding, providing executive updates and managing risks and expectations.
Partner with Operations, Product, Engineering, and Clinical teams to resolve blockers and turn client feedback into product and process improvements.
Hand off clients to Account Management and Client Services and identify opportunities to expand the use of Alaffia’s AI tools within client environments.
Join late-stage sales conversations to scope implementation approach, timelines, and feasibility.
Mentor and develop implementation and solutions team members.