Healthcare Payment Integrity Associate Director
About The Position
Lead multiple concurrent transformation engagements for federal health clients, owning delivery quality, workplans, staffing, budgets, executive communications, and integrated storylines across workstreams. Serve as a senior SME in clinical documentation integrity, coding, revenue integrity, reimbursement, payment policy, and payment integrity, translating subject-matter depth into practical transformation roadmaps and operating model decisions. Advise senior client stakeholders on the intersection of documentation, coding, claims/payment accuracy, quality measurement, utilization, denials, compliance, and financial performance. Assess current-state workflows, documentation practices, coding operations, and performance drivers; identify root causes; and define target-state processes, governance, controls, and measurable improvement opportunities. Apply payer-provider expertise to federal health environments, connecting reimbursement mechanics, classification systems, payment policy, risk adjustment, and incentive structures to operational and clinical outcomes. Guide analytics-enabled transformation by using claims, revenue cycle, coding, and operational data to generate insights, size opportunities, prioritize interventions, and monitor value realization. Partner with clinical, operational, IT, compliance, and finance leaders to design sustainable improvements in documentation quality, coding accuracy, audit readiness, provider education, and workflow efficiency. Develop executive-ready deliverables, workshops, and decision materials that clearly communicate the “so what” for C-suite, program, and operational leadership. Build and mentor high-performing teams through apprenticeship-style coaching, including upskilling staff in clinical documentation, coding, reimbursement, analytics, and client relationship management. Drive business development and practice growth by shaping solution offerings, supporting proposals, developing reusable assets, and bringing thought leadership in CDI, coding optimization, payment integrity, and healthcare data strategy.
Requirements
- Bachelor’s degree required
- 10+ years of healthcare consulting and/or industry leadership experience spanning payer, provider, revenue cycle, health information, reimbursement, or federal health transformation environments.
- Deep expertise in clinical documentation, coding, reimbursement/payment policy, revenue integrity, payment integrity, and/or healthcare performance improvement.
- Demonstrated success leading complex, cross-functional engagements with accountability for client outcomes, delivery quality, team leadership, and executive stakeholder management.
- Strong payer-provider lens, including understanding of claims/payment operations, documentation and coding impacts, reimbursement methodologies, and policy-driven operational change.
- Experience translating data into action, including opportunity sizing, root-cause analysis, performance measurement, dashboarding, and executive synthesis.
- Ability to educate and influence diverse stakeholders, including clinicians, coding teams, operations leaders, finance executives, and government clients.
- Ability to obtain a Public Trust clearance (i.e. US citizenship required).
- Willingness to travel as needed (up to 25%).
Nice To Haves
- Master of Health Administration, MBA, MPH, or other relevant advanced degree strongly preferred.
- AAPC and/or AHIMA coding credentials (e.g., CPC, CCS, RHIA, RHIT, CDIP, CCDS) and demonstrated credibility in documentation and coding education.
- Experience with healthcare technology, classification systems, or clinical documentation/coding solution environments, including analytics-enabled or AI-supported transformation.
- Experience across payer advisory, health information/coding vendors, professional associations, or consulting environments supporting reimbursement and payment operations.
- Knowledge of revenue cycle, DRG validation, audit/compliance, utilization or quality improvement, risk adjustment, and fraud, waste, and abuse or payment-integrity concepts.
- Experience designing education programs, thought leadership, or market-facing content for coding, documentation, reimbursement, or health information audiences.
Responsibilities
- Lead multiple concurrent transformation engagements for federal health clients, owning delivery quality, workplans, staffing, budgets, executive communications, and integrated storylines across workstreams.
- Serve as a senior SME in clinical documentation integrity, coding, revenue integrity, reimbursement, payment policy, and payment integrity, translating subject-matter depth into practical transformation roadmaps and operating model decisions.
- Advise senior client stakeholders on the intersection of documentation, coding, claims/payment accuracy, quality measurement, utilization, denials, compliance, and financial performance.
- Assess current-state workflows, documentation practices, coding operations, and performance drivers; identify root causes; and define target-state processes, governance, controls, and measurable improvement opportunities.
- Apply payer-provider expertise to federal health environments, connecting reimbursement mechanics, classification systems, payment policy, risk adjustment, and incentive structures to operational and clinical outcomes.
- Guide analytics-enabled transformation by using claims, revenue cycle, coding, and operational data to generate insights, size opportunities, prioritize interventions, and monitor value realization.
- Partner with clinical, operational, IT, compliance, and finance leaders to design sustainable improvements in documentation quality, coding accuracy, audit readiness, provider education, and workflow efficiency.
- Develop executive-ready deliverables, workshops, and decision materials that clearly communicate the “so what” for C-suite, program, and operational leadership.
- Build and mentor high-performing teams through apprenticeship-style coaching, including upskilling staff in clinical documentation, coding, reimbursement, analytics, and client relationship management.
- Drive business development and practice growth by shaping solution offerings, supporting proposals, developing reusable assets, and bringing thought leadership in CDI, coding optimization, payment integrity, and healthcare data strategy.
Benefits
- Medical, Rx, Dental & Vision Insurance
- Personal and Family Sick Time & Company Paid Holidays
- Position may be eligible for a discretionary variable incentive bonus
- Parental Leave and Adoption Assistance
- 401(k) Retirement Plan
- Basic Life & Supplemental Life
- Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
- Short-Term & Long-Term Disability
- Student Loan PayDown
- Tuition Reimbursement, Personal Development & Learning Opportunities
- Skills Development & Certifications
- Employee Referral Program
- Corporate Sponsored Events & Community Outreach
- Emergency Back-Up Childcare Program
- Mobility Stipend
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What This Job Offers
Job Type
Full-time
Career Level
Senior
