VP, Payment Integrity
2 мес. назад
207k–304k USD / yearC-levelRemote
Lead the strategy and performance of payment integrity to ensure accurate claims payment and compliance.
О компании
- We know healthcare. Our company was founded and is still led by industry veterans who have started and grown several market-leading companies in the space.
- We have raised money from top tier investors who share the same long-term vision as we do of building an industry defining company that will endure over the long run. We are well capitalized.
- Our clients love us. Customer satisfaction rates among employees using health plans consistently rank above 80% – nearly 40 points above the industry average.
- Our culture is unique. We tend to be non-hierarchical, merit-driven, opinionated but kind people who thrive working in a high-performance, fast-paced environment. People at care deeply about making a positive impact in the lives of the people we serve.
Обязанности
- The VP of Payment Integrity is responsible for the leadership, strategy, and performance of ’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 ’s growth strategy.
Требования
- 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
Условия
- Our unique benefits program is the gravy, i.e., the special sauce that sets our compensation package apart. In addition to standard health and wellness benefits, ’s package includes alternative medicine coverage, flexible PTO, up to 16 weeks paid parental leave, paid holidays, a 401k program, transportation perks, education reimbursement, and 2 days of paid paw-ternity leave.
Другое
- Hi, we’re . Our mission is to create health benefits that actually benefit small and midsize businesses and their employees. Our innovative benefit solutions and services are developed and delivered by a diverse group of unique people. We encourage you to be your authentic self - we like you that way.
- 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