Vice President, Payor Services - Payment Integrity

Vice President, Payor Services - Payment Integrity at Confidential Vice President, Payor Services - Payment Integrity at Confidential in Oakland, California Posted in about 15 hours ago.

Type:

full-time

Job Description:

We are seeking a strategic and operational leader to oversee and expand our Federal Payment Integrity business. This executive will be responsible for driving growth, building a market-leading team, and partnering closely with technical and operational stakeholders to deliver innovative payment integrity solutions. This role will serve as a member of the executive leadership team. This is a fast-paced environment requiring independent decision-making, strong business judgment, and the ability to navigate ambiguity. The ideal candidate is mission-driven, highly collaborative, and comfortable leading in a dynamic and evolving organization. Position Summary The Vice President, Payment Integrity is responsible for the day-to-day leadership and execution of all operational components of the Payment Integrity organization. As a key member of the operations leadership team, this individual will drive profitable growth through the use of technology, data analytics, and intelligent automation to transform processes and increase savings for clients.

Essential Responsibilities:

Provide leadership and strategic direction for payment integrity operations to ensure business and financial objectives are achieved or exceeded. Partner with Business Development, Client Delivery, Coding Compliance, and Data Engineering teams to expand payment integrity solution capabilities and deliver increased client value. Analyze, evaluate, and recommend strategic initiatives aligned with the future vision of payment integrity operations. Coach and mentor staff while fostering innovative approaches to payment integrity solutions. Build and lead a high-performing, motivated, and collaborative team environment. Establish clear performance expectations, provide ongoing feedback, and support employee development. Develop and communicate short- and long-term departmental goals and monitor performance against objectives. Recommend and implement policies, standards, procedures, and operational improvements. Maintain and strengthen relationships with client agencies to ensure alignment, satisfaction, and value delivery. Drive operational excellence through continuous process improvement and implementation of best practices. Communicate operational performance and strategic outcomes to executive leadership and clients through dashboards, reports, and presentations. Lead enterprise-wide initiatives designed to address critical business challenges and organizational objectives.

Qualifications & Experience:

Proven track record of building strong relationships across teams and with executive stakeholders. Exceptional communication skills with the ability to articulate complex concepts clearly and persuasively. Demonstrated success leading enterprise initiatives and operational transformation efforts.

Strong knowledge of:

Managed Care, Medicare, and/or Medicaid Pre-payment and retrospective payment integrity auditing Claims coding, regulatory requirements, and medical policy Industry best practices related to Payment Integrity Minimum 15+ years of healthcare industry experience. Minimum 10+ years of healthcare payment integrity experience, including: Medical claims auditing Contract compliance Provider billing compliance Coordination of benefits Improper payment root cause analysis Ability and willingness to remain hands-on in supporting client needs and team development.

Additional Requirements:

Must be a U.S. Citizen. Must be authorized to work in the United States. Travel required up to 50%.

Work Location:

Hybrid work arrangement in the San Francisco Bay Area or Remote within the United States. Benefits Medical Insurance Dental Insurance Vision Insurance 401(k) Paid Time Off (PTO)