VP, Payment Integrity

Gravie

52d•$207,000 - $304,000

About The Position

The VP of Payment Integrity is responsible for the leadership, strategy, and performance of Gravie’s payment integrity function, ensuring claims are paid accurately and in compliance with all applicable policies. This role will be responsible for driving the strategy for our pre- and post-pay payment integrity programs, including vendor and internal solutions, and building and leading a high performing team to execute on our strategy. This leader will partner closely with Claims, Network, Product, Technology, Finance, Clinical, Legal/Compliance, and external partners to continuously improve claims payment outcomes, drive plan affordability, and enable Gravie’s growth strategy.

Requirements

15+ years of progressive leadership experience in healthcare claims or payment integrity operations, including significant executive-level responsibility
Deep expertise in medical claims operations, payment integrity, claims configuration, and regulatory compliance
Proven experience scaling operational organizations in high-growth or complex environments
Strong understanding of healthcare regulations, audit requirements, and industry best practices
Demonstrated ability to lead large, distributed teams and manage complex vendor relationships
Strategic thinker with strong analytical, financial, and operational acumen

Responsibilities

Lead payment integrity strategy and execution, including pre- and post-payment reviews, fraud, waste, and abuse (FWA) prevention, and recovery efforts
Design and lead solutions to address leakage throughout the claims lifecycle, including developing internal capabilities and implementing external vendor programs
Assess the current payment integrity program ecosystem and prioritize opportunities to deliver additional savings
Build and manage a high-performing multi-vendor portfolio, enforcing rigorous SLAs and optimizing contingency fee structures to maximize financial yields while actively mitigating provider abrasion
Provide executive leadership over all payment integrity operations, ensuring high performance of all internal and external PI programs
Lead strategy and execution to insource payment integrity opportunities as appropriate
Establish and monitor savings and operational KPIs
Develop, scale and optimize payment integrity operations to support business growth, new products, and regulatory requirements
Partner with Finance and Med Econ to ensure detailed savings tracking of payment integrity initiatives
Build, mentor, and lead a high-performing leadership team with a strong culture of accountability, collaboration, and continuous improvement
Build strong leadership and career pathways within the organization to support retention and succession planning