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 solution s across the HealthEdge ecosystem.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• 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

• Leverage AI, analytics, automation, and emerging healthcare technologies to lead innovation strategies

• Develop and execute 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

• Establish payment integrity roadmap priorities in alignment with product, technology, and market strategies

• 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

• 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’s 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

• 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

• Foster a culture of collaboration, continuous improvement, and results orientation

• 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

• 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

• 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

• 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

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.