Director, Payment Integrity Strategy
Abacus Insights
full-time
Posted on:
Location Type: Remote
Location: United States
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Job Level
About the role
- Act as a strategic leader for payment integrity across Abacus, shaping internal approaches to pre‑pay, post‑pay, recovery, and FWA‑related use cases.
- Partner closely with Product, Engineering, Analytics, and Delivery teams to guide the design and evolution of payment integrity‑related capabilities, workflows, and analytical approaches.
- Translate complex payment integrity findings, data patterns, and industry practices into clear insights, narratives, and recommendations for internal stakeholders and leadership.
- Review and guide analytical methodologies to ensure accuracy, relevance, and alignment with payer operational realities.
- Contribute to internal frameworks, playbooks, and documentation that enable consistent, scalable payment integrity practices across teams.
- Serve as a thought partner to senior leaders on industry trends, regulatory considerations, and emerging payment integrity strategies.
- Support internal enablement by sharing expertise, best practices, and lessons learned to raise organizational fluency in payment integrity.
Requirements
- Bachelor’s degree in a related field (e.g., healthcare administration, business, analytics, or similar) or equivalent work experience.
- 10+ years of experience in healthcare payer environments with deep expertise in payment integrity, claims analytics, overpayment identification, recovery, and FWA concepts.
- Prior experience in healthcare technology, analytics platforms, or data‑enabled services.
- Deep hands-on experience in pre-pay, claim audit/complex claim review, and medical coding/auditing.
- Strong understanding of CMS and state-level regulatory policies and guidelines.
- Strong understanding of payer operations and how payment integrity strategies translate into measurable financial and operational outcomes.
- Able to apply business logic and subject matter expertise to translate payment integrity data sources into pre-pay and post-pay payment integrity solutions.
- Experience partnering with Product, Engineering, Analytics, Sales, and Operations teams in a data‑driven technology or SaaS environment.
- Strong communication and presentation skills.
- Strategic mindset, intellectual curiosity, and comfort operating in a fast‑paced, growth‑oriented organization.
Benefits
- Unlimited paid time off
- Work from anywhere
- Comprehensive health coverage
- Equity for every employee
- Growth-focused environment
- Home office setup allowance
- Monthly cell phone allowance
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
payment integrityclaims analyticsoverpayment identificationrecoveryFWA conceptsmedical codingclaim auditdata analysisanalytical methodologiesbusiness logic
Soft Skills
strategic leadershipcommunication skillspresentation skillsintellectual curiositycollaborationthought partnershiporganizational fluencyadaptabilityproblem-solvingcritical thinking