VP, Payment Integrity
About The Position
HealthEdge is seeking a Vice President, Payment Integrity to lead the strategy, market positioning, financial performance, and operational execution of payment integrity solutions across its ecosystem. The role sets the long-term vision and commercialization strategy for payment integrity capabilities, aligning them with enterprise growth objectives, client outcomes, and market needs. The VP is accountable for business performance, innovation, external market leadership, and measurable value across clients and product portfolios, and influences investment priorities, strategic partnerships, and HealthEdge’s presence in the industry. The role leads payment integrity strategy and execution, including the operating model, roadmap, portfolio performance, growth, financial objectives, innovation, investment cases, pricing, and go-to-market alignment. It partners with Product, Technology, Data, Analytics, Sales, Operations, Finance, and Client Success to establish roadmap priorities and deliver integrated, client-centric solutions. The VP leads executive client engagement, strategic relationships, adoption, value realization, retention, expansion, and the use of client insights to inform ongoing product development. The VP builds and develops the payment integrity organization, establishes performance expectations and operating rhythms, and leads succession planning, leadership development, and organizational design. The role also establishes governance, operating standards, compliance strategies, analytics practices, executive reporting, and performance metrics. It works with executive leadership on investments, partnerships, acquisitions, and market expansion, and represents HealthEdge externally as a payment integrity spokesperson and thought leader. This is a remote US position. The role involves working across multiple time zones, extended periods sitting and/or standing at a computer using video technology, occasional movement around an office, and possible travel depending on company needs. Candidates may be required to complete a pre-employment criminal background check. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.
Requirements
- Bachelor’s degree required.
- 10–15+ years of experience in healthcare, payment integrity, claims operations, or a 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 in complex matrixed organizations.
- Experience leading through organizational scale, transformation, and change management initiatives.
- Strong communication and presentation skills for technical and non-technical audiences.
- Ability to build credibility with internal stakeholders and clients.
- Ability to navigate complex environments and drive alignment across teams.
Nice To Haves
- Advanced degree, such as an MBA, MHA, or MPH.
- Familiarity with CMS guidelines and broader regulatory frameworks.
- Experience representing organizations externally through conferences, advisory boards, publications, or analyst engagements.
Responsibilities
- Own the end-to-end payment integrity business strategy, operating model, and execution roadmap across the HealthEdge ecosystem.
- Manage portfolio performance, business growth, and financial objectives for payment integrity solutions.
- Define and execute a multi-year vision and transformation roadmap for payment integrity capabilities across the HealthEdge platform.
- Drive innovation using 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.
- Set 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 in partnership with Data teams.
- Align teams to deliver integrated, client-centric solutions.
- Lead executive-level client engagement strategies to accelerate adoption, value realization, retention, and expansion.
- Build and maintain strategic relationships with executive stakeholders at payer organizations and with industry partners.
- Represent HealthEdge as an executive spokesperson and thought leader on payment integrity strategy and innovation.
- Bring client insights forward to inform product development and continuous improvement.
- Own expansion opportunities through demonstrated client value and outcomes.
- Build and evolve a payment integrity organization to support long-term growth and market expansion.
- Establish operating rhythms, performance expectations, and accountability across the team.
- Drive succession planning, leadership development, and organizational design across the function.
- Build team capability in payment integrity methodologies, analytics, and client delivery.
- Foster collaboration, continuous improvement, and results orientation.
- Establish enterprise governance frameworks, operating standards, and compliance strategies for payment integrity solutions and methodologies.
- Advance enterprise decision-making through 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.
- Align Product, Technology, Sales, Operations, Finance, and Client Success leaders to execute payment integrity priorities.
- Influence enterprise investment decisions, operating models, and strategic planning 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 in executive leadership forums.
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What This Job Offers
Job Type
Full-time
Career Level
Executive
