VP, Payment Integrity

HealthEdge

Vice President of Payment Integrity leading strategy and execution across HealthEdge's payment integrity solutions. Responsible for business performance and client engagement in the healthcare sector.

Posted 6/26/2026full-timeRemote • 🇺🇸 United StatesLead💰 $240,000 - $265,000 per yearWebsite

About the role

Key responsibilities & impact

Own the end-to-end payment integrity business strategy, operating model, and execution roadmap across the HealthEdge ecosystem
Accountable for portfolio performance, business growth, and achievement of financial objectives associated with payment integrity solutions
Define and execute a multi-year vision and transformation roadmap for payment integrity capabilities across the HealthEdge platform
Drive innovation strategies leveraging AI, analytics, automation, and emerging healthcare technologies
Lead business case development and investment strategies for new capabilities, partnerships, and market opportunities
Establish payment integrity roadmap priorities in alignment with product, technology, and market strategies
Drive executive-level client engagement strategies to accelerate adoption, retention, and expansion of payment integrity solutions
Build and maintain strategic relationships with executive stakeholders across payer organizations and industry partners
Establish clear operating rhythms, performance expectations, and accountability across the team
Drive enterprise analytics strategy and insight-driven innovation for payment integrity capabilities in partnership with Data teams
Partner with Data and Analytics teams to ensure accuracy, consistency, and rigor in payment integrity outputs
Establish governance frameworks, executive reporting structures, and performance metrics to measure business impact and operational effectiveness
Represent payment integrity priorities and business performance within executive leadership forums.

Requirements

What you’ll need

Bachelor’s degree required
Advanced degree (MBA, MHA, MPH) preferred
10–15+ years of experience in healthcare, payment integrity, claims operations, or related field
7+ years of senior leadership experience
Experience working within healthcare technology, payer organizations, or related services environments
Strong expertise in payment integrity methodologies, including claims editing, payment policy, and cost containment strategies
Solid understanding of healthcare reimbursement models, payer operations, and regulatory considerations
Experience working with healthcare data, analytics, and technology-enabled solutions
Familiarity with CMS guidelines and broader regulatory frameworks preferred
Demonstrated success leading enterprise-scale healthcare or payment integrity transformation initiatives
Proven ability to influence executive stakeholders, enterprise strategy, and investment prioritization decisions
Experience owning business outcomes, growth strategies, and operational performance within complex matrixed organizations
Recognized industry leader with experience representing organizations externally through conferences, advisory boards, publications, or analyst engagements
Experience leading through organizational scale, transformation, and change management initiatives
Strong communication and presentation skills across technical and non-technical audiences
Ability to build credibility with internal stakeholders and clients
Skilled at navigating complex environments and driving alignment across teams.

Benefits

Comp & perks

HealthEdge is an equal opportunity employer
Committed to workforce diversity
Actively encourage all qualified persons to seek employment with us

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Applicant Tracking System Keywords

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Hard Skills & Tools

payment integrityclaims operationshealthcare dataanalyticshealthcare technologycost containment strategiesclaims editingpayment policyhealthcare reimbursement modelsregulatory considerations

Soft Skills

leadershipcommunicationpresentation skillsinfluencerelationship buildingstrategic thinkingchange managementorganizational navigationaccountabilityinnovation

Certifications

Bachelor’s degreeMBAMHAMPH