Vice President, Payment Integrity

Somatus, Inc. • McLean, VA

12h

About The Position

At Somatus, care goes beyond treatment. Through our whole-person approach, we’re redefining what care looks like — showing up #SomatusStrong for our teammates and patients. Our mission: to be the world’s best value-based care provider of integrated kidney and cardiovascular care.
With a focus on chronic kidney and cardiovascular health, we partner closely with health plans, health systems, and provider groups to deliver integrated care for patients with, or at risk of, kidney disease, congestive heart failure, and related conditions.
From clinicians and advocates to strategists, we hire exceptional talent — the brightest and boldest — each playing a critical role in driving change and creating healthier futures for patients.
Does this sound like you? Keep reading.
Since our founding in 2016, our growth trajectory isn’t just a milestone — it’s a signal. You won’t need to convince anyone here of the power of culture — our leadership is already leading with intention. We’re entering a bold new chapter of reflection, renewal, and reinvention.
How We’ll Support You:
We offer 25+ health, growth, and wealth work perks to help teammates be the best version of themselves, including:
Subsidized personal healthcare coverage: Medical, Dental & Vision, plus Wellness programs
Paid Time Off: [Insert accurate PTO for employee group]
Professional development: CEU and tuition reimbursement

How You’ll Make an Impact:
Are you ready to roll up your sleeves to protect and optimize revenue streams while keeping your eye on the big picture? This confidential opportunity is for a Vice President of Medicare Advantage Revenue Integrity who will safeguard and enhance Medicare Advantage revenue tied to ESRD status, Medicare Secondary Payer, and related CMS payment processes.
We’re entering an exciting visionary phase of growth: a time of reflection, renewal, and reinvention. We’re not afraid to acknowledge past lessons learned and growing pains. We’re building a future where revenue integrity is a strategic engine for growth, connection, and innovation – and you’ll be at the center of it all. Reporting directly to one of our senior leaders, you’ll partner across departments, influence strategy, and lead initiatives that bring our mission to life.
This role isn’t just about oversight; it’s about owning the end-to-end process for identifying, quantifying, correcting, and preventing revenue leakage tied to incorrect CMS payment designations. You’ll collaborate with actuarial, government programs, data, compliance, operations, and external partners to drive material improvements in capitation accuracy and financial performance.
This is a high-visibility, high-impact role with direct influence on organizational EBITDA. If you’re ready to lead with precision and vision, this is your moment.

Requirements

• A Medicare Advantage Maven – 10+ years of experience in Medicare Advantage with direct ownership of payment integrity or revenue integrity operations. You know the landscape inside and out and can navigate CMS payment policies with precision.
• A Policy Powerhouse – Deep understanding of CMS payment processes and the ability to amend errors with confidence. You’re the go-to expert when accuracy matters most.
• A Revenue Impact Driver – Proven ability to deliver measurable financial results and operational improvements. You don’t just manage processes, you transform them.
• A Cross-Functional Influencer – Skilled at managing teams and influencing senior executives. You thrive in complex environments and know how to bring people together to achieve big goals.
• An Analytical Architect – Strong analytical and process design capabilities. You see patterns others miss and build systems that scale.

Nice To Haves

• A Builder of Integrity – Experience managing or building revenue integrity operations from the ground up.
• A Strategic Partner – Prior leadership in actuarial, finance, or government programs.
• A Relationship Manager – Ability to manage external partners and align them to organizational goals.

Responsibilities

• Own the enterprise revenue integrity strategy across all MAPD and DSNP members.
• Establish and manage a multi-year roadmap to eliminate systemic revenue leakage and ensure CMS payment accuracy.
• Advise executive leadership on operational opportunities and forecasted revenue impacts.
• Lead a high-performing team across analytics and operations.
• Maintain KPIs, dashboards and audit programs to measure financial impact and throughput.
• Implement technology enabled workflows.
• Oversee applicable external relationships.
• Quantify revenue opportunities and deliver a predictable, auditable financial impact.
• Partner with actuarial and finance to forecast uplift tied to revenue integrity efforts.
• Ensure all internal processes remain aligned with CMS guidance.

Benefits

• Subsidized personal healthcare coverage: Medical, Dental & Vision, plus Wellness programs
• Paid Time Off: [Insert accurate PTO for employee group]
• Professional development: CEU and tuition reimbursement

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed
• Number of Employees: 251-500 employees