About The Position
Experian Health is seeking a Vice President, Clearinghouse & Payer Operations to provide strategic leadership and operational execution for clearinghouse and payer-facing transaction services. This role is crucial for ensuring the performance, availability, scalability, and regulatory compliance of electronic data interchange transactions connecting providers, payers, and healthcare networks. The position reports to the Chief Client Officer and will drive operational excellence across real-time and batch clearinghouses, covering claims, eligibility, remittance, prior authorization, and other payer connectivity services. The goal is to leverage Experian's data, analytics, and automation to enhance transaction efficiency, performance, contract adherence, and client outcomes.
Requirements
- 15+ years of applicable leadership experience in healthcare operations, clearinghouse services, payer operations, revenue cycle technology/services, or health IT.
- Demonstrated experience leading large-scale, high-volume transaction processing organizations.
- Deep expertise in healthcare EDI standards and transactions (837, 835, 270/271, 276/277, 278).
- Understanding of EPIC, Oracle, Meditech registration workflow.
- Strong understanding of payer-provider workflows and reimbursement processes.
- Proven ability to lead cross-functional teams in complex, regulated environments.
- Experience working with national and regional payer networks.
Nice To Haves
- Preferred experience in operational transformation, automation, or AI-enabled healthcare operations.
- Customer-first mindset aligned with Experian Health's mission to simplify healthcare payments.
- Data-driven decision making leveraging Experian analytics and insights.
- Strong executive communication and stakeholder management.
- Change leadership and continuous improvement orientation.
- Talent development and inclusive leadership.
Responsibilities
- Define and execute the clearinghouse and payer operations strategy in alignment with Experian Health's growth, margin, and platform modernization objectives.
- Translate enterprise strategy into scalable operating models, KPIs, and service-level commitments across payer-facing clearinghouses.
- Lead transformation initiatives focused on automation, AI-driven operations, and modernization.
- Own operational budgets, forecasting, and cost management for clearinghouse and payer operations.
- Own end-to-end operational performance of Experian Health's real-time and batch clearinghouses.
- Ensure high availability, throughput, accuracy, and SLA conformance across transaction types.
- Partner with Engineering, InfoSec and Product to support platform resilience, modernization, capacity planning, and redundancy.
- Oversee payer contracting, onboarding, connectivity, testing, certification, and ongoing operational performance.
- Serve as the executive escalation point for payer-related incidents, outages, and performance issues.
- Build strong operational partnerships with national and regional payers to improve acceptance rates, turnaround times, and data quality.
- Ensure compliance with HIPAA, X12, CMS, FHIR, etc. state regulations, and payer contractual obligations.
- Partner with Compliance, Legal, Security, and Privacy teams to manage audits, incidents, and regulatory changes.
- Own operational risk management, business continuity planning, and disaster recovery readiness for transaction services.
- Collaborate with Product Management and Engineering to align operational capabilities with Experian Health's product roadmap and new service launches.
- Partner with Sales and Client Success to support large enterprise clients, strategic deals, and escalations.
- Work closely with Data, Analytics, and Platform teams to leverage Experian assets for operational insights and payer optimization.
Benefits
- Comprehensive executive level total rewards package
- Flexible time off including unlimited vacation, volunteer time off, and 12 paid holidays
- Core benefits including medical, dental, vision, and matching 401K
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What This Job Offers
Job Type
Full-time
Career Level
Executive
Education Level
No Education Listed
