VP, Payment Integrity

HealthEdge•Remote,

1d•$240,000 - $265,000•Remote

About The Position

HealthEdge is seeking a Vice President, Payment Integrity to own the strategy, market positioning, financial performance, and operational execution of payment integrity solutions across the HealthEdge ecosystem. This executive leader will drive the long-term vision and commercialization strategy for payment integrity capabilities, ensuring alignment with enterprise growth objectives, client outcomes, and evolving market demands. The VP will be accountable for business performance, innovation strategy, external market leadership, and delivery of measurable value across clients and product portfolios for Payment Integrity. This leader will influence investment priorities, shape strategic partnerships, and represent HealthEdge as an industry thought leader with clients, analysts, and industry forums.

Requirements

Bachelor’s degree required
10–15+ years of experience in healthcare, payment integrity, claims operations, or related field
7+ years of senior leadership experience
Experience working within healthcare technology, payer organizations, or related services environments
Strong expertise in payment integrity methodologies, including claims editing, payment policy, and cost containment strategies
Solid understanding of healthcare reimbursement models, payer operations, and regulatory considerations
Experience working with healthcare data, analytics, and technology-enabled solutions
Demonstrated success leading enterprise-scale healthcare or payment integrity transformation initiatives
Proven ability to influence executive stakeholders, enterprise strategy, and investment prioritization decisions
Experience owning business outcomes, growth strategies, and operational performance within complex matrixed organizations
Recognized industry leader with experience representing organizations externally through conferences, advisory boards, publications, or analyst engagements
Experience leading through organizational scale, transformation, and change management initiatives
Strong communication and presentation skills across technical and non-technical audiences
Ability to build credibility with internal stakeholders and clients
Skilled at navigating complex environments and driving alignment across teams

Nice To Haves

advanced degree (MBA, MHA, MPH) preferred
Familiarity with CMS guidelines and broader regulatory frameworks preferred

Responsibilities

Own the end-to-end payment integrity business strategy, operating model, and execution roadmap across the HealthEdge ecosystem
Accountable for portfolio performance, business growth, and achievement of financial objectives associated with payment integrity solutions
Define and execute a multi-year vision and transformation roadmap for payment integrity capabilities across the HealthEdge platform
Drive innovation strategies leveraging AI, analytics, automation, and emerging healthcare technologies
Lead business case development and investment strategies for new capabilities, partnerships, and market opportunities
Influence pricing, commercialization strategy, and go-to-market alignment for payment integrity offerings
Establish payment integrity roadmap priorities in alignment with product, technology, and market strategies
Serve as the enterprise authority on payment integrity strategy, claims accuracy, payment policy, and cost containment innovation
Drive enterprise analytics strategy and insight-driven innovation for payment integrity capabilities in partnership with Data teams
Ensure alignment across teams to deliver integrated, client-centric solutions
Drive executive-level client engagement strategies to accelerate adoption, value realization, retention, and expansion of payment integrity solutions
Build and maintain strategic relationships with executive stakeholders across payer organizations and industry partners
Serve as HealthEdge’s executive spokesperson and thought leader for payment integrity strategy and innovation
Bring forward client insights to inform product development and continuous improvement
Own expansion opportunities through demonstrated client value and outcomes
Build and evolve a payment integrity organization capable of supporting long-term business growth and market expansion
Establish clear operating rhythms, performance expectations, and accountability across the team
Drive succession planning, leadership development, and organizational design strategies across the function
Build team capability in payment integrity methodologies, analytics, and client delivery
Foster a culture of collaboration, continuous improvement, and results orientation
Establish enterprise governance frameworks, operating standards, and compliance strategies for payment integrity solutions and methodologies
Drive enterprise decision-making through advanced analytics, performance insights, and predictive payment integrity strategies
Partner with Data and Analytics teams to ensure accuracy, consistency, and rigor in payment integrity outputs
Support development of analytical methodologies and validation approaches aligned with industry standards
Drive alignment across Product, Technology, Sales, Operations, Finance, and Client Success leaders to ensure execution of payment integrity priorities
Influence enterprise investment decisions, operating models, and strategic planning activities related to payment integrity capabilities
Establish governance frameworks, executive reporting structures, and performance metrics to measure business impact and operational effectiveness
Partner with executive leadership to identify acquisition, partnership, and market expansion opportunities
Represent payment integrity priorities and business performance within executive leadership forums