The Company is seeking a Vice President, Payment Integrity to lead the strategic and operational aspects of the enterprise Payment Integrity function. The successful candidate will be responsible for developing and executing a multi-year Payment Integrity strategy that aligns with the company's mission of serving seniors and those in need. This role demands a leader with a strong background in healthcare Payment Integrity, particularly on the payer side, and a proven track record of driving financial and operational outcomes. The VP will be tasked with evolving the Payment Integrity ecosystem, with a focus on prospective prevention and first-pass payment accuracy, while maintaining a balance between financial objectives and the company's commitment to provider relationships and member experience. Candidates for this role must have a minimum of 12 years' experience in healthcare Payment Integrity, claims operations, or a related function, with at least 7 years in leadership roles. A deep understanding of prepay and postpay disciplines, as well as reimbursement methodology and coding standards, is essential. The VP will also be responsible for vendor management, including selection, negotiation, and performance evaluation, and must demonstrate the ability to influence and align with leaders across various functions. The ideal candidate will have a Bachelor's degree in a relevant field, with a preference for a Master's degree, and a strong background in strategic leadership, financial acumen, and transformation management. Experience in Medicare Advantage and with AI/ML-driven Payment Integrity solutions is a plus.

Hiring Company

Alignment Health