VP, Payment Integrity

Overview: HealthEdge is seeking a Vice President, Payment Integrity to own the strategy, market positioning, financial performance, and operational execution of payment integrity solutions across the HealthEdge ecosystem. This executive leader will drive the long-term vision and commercialization strategy for payment integrity capabilities, ensuring alignment with enterprise growth objectives, client outcomes, and evolving market demands. The VP will be accountable for business performance, innovation strategy, external market leadership, and delivery of measurable value across clients and product portfolios for Payment Integrity. This leader will influence investment priorities, shape strategic partnerships, and represent HealthEdge as an industry thought leader with clients, analysts, and industry forums. ESSENTIAL DUTIES AND RESPONSIBILITIES: Payment Integrity Strategy & Execution 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 Influence pricing, commercialization strategy, and go-to-market alignment for payment integrity offerings Product & Cross-Functional Partnership Establish payment integrity roadmap priorities in alignment with product, technology, and market strategies Serve as the enterprise authority on payment integrity strategy, claims accuracy, payment policy, and cost containment innovation Drive enterprise analytics strategy and insight-driven innovation for payment integrity capabilities in partnership with Data teams Ensure alignment across teams to deliver integrated, client-centric solutions Client Impact & Value Realization Drive executive-level client engagement strategies to accelerate adoption, value realization, retention, and expansion of payment integrity solutions Build and maintain strategic relationships with executive stakeholders across payer organizations and industry partners Serve as HealthEdge executive spokesperson and thought leader for payment integrity strategy and innovation Bring forward client insights to inform product development and continuous improvement Own expansion opportunities through demonstrated client value and outcomes Team Leadership & Organizational Effectiveness Build and evolve a payment integrity organization capable of supporting long-term business growth and market expansion Establish clear operating rhythms, performance expectations, and accountability across the team Drive succession planning, leadership development, and organizational design strategies across the function Build team capability in payment integrity methodologies, analytics, and client delivery Foster a culture of collaboration, continuous improvement, and results orientation Data, Analytics & Operational Rigor Establish enterprise governance frameworks, operating standards, and compliance strategies for payment integrity solutions and methodologies Drive enterprise decision-making through advanced analytics, performance insights, and predictive payment integrity strategies Partner with Data and Analytics teams to ensure accuracy, consistency, and rigor in payment integrity outputs Support development of analytical methodologies and validation approaches aligned with industry standards Enterprise Leadership & Governance Drive alignment across Product, Technology, Sales, Operations, Finance, and Client Success leaders to ensure execution of payment integrity priorities Influence enterprise investment decisions, operating models, and strategic planning activities related to payment integrity capabilities Establish governance frameworks, executive reporting structures, and performance metrics to measure business impact and operational effectiveness Partner with executive leadership to identify acquisition, partnership, and market expansion opportunities Represent payment integrity priorities and business performance within executive leadership forums MINIMUM REQUIRED QUALIFICATIONS Education & Experience 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 Domain Expertise 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 Leadership & Execution 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 Communication & Influence 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 Geographic Responsibility: Remote, US Type of Employment: Full-time, permanent FLSA Classification (USA Only): Exempt Work Environment: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job: The employee is occasionally required to move around the office. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus. Work across multiple time zones in a hybrid or remote work environment. Long periods of time sitting and/or standing in front of a computer using video technology. May require travel dependent on company needs. HealthEdge reserves the right to modify, add, or remove duties and to assign other duties as necessary. Candidates may be required to go through a pre-employment criminal background check. HealthEdge is an equal opportunity employer. We are committed to workforce diversity and actively encourage all qualified persons to seek employment with us, including, but not limited to, racial and ethnic minorities, women, veterans and persons with disabilities. The annual US base salary range for this position is $240,000 to $265,000. This salary range may cover multiple career levels at HealthEdge. Final compensation will bedeterminedduring the interview process and is based on a combination of factors including, but not limited to,your skills, experience,qualificationsand education. #J-18808-Ljbffr