[Hiring] Vice President, Payment Integrity @Alignment Health

Role Description

The Vice President, Payment Integrity serves as the senior executive accountable for Alignment Health's enterprise Payment Integrity function and its contribution to payment accuracy, affordability, and medical cost performance. This leader will develop and lead execution of the Payment Integrity strategy, build and scale a high-performing organization, and establish the optimal mix of internal capabilities, technology, and strategic vendor partnerships across prepay and postpay programs.

Alignment's Payment Integrity program currently combines a small internal team with a large vendor footprint. The VP will provide executive leadership over the evolution of the Payment Integrity ecosystem, recommending build, buy, consolidate, insource, and retire decisions and holding internal leaders and external partners accountable for measurable, validated financial and operational outcomes. The VP will also lead the strategic shift from retrospective recovery toward prospective prevention and first-pass payment accuracy while protecting provider relationships, member experience, and regulatory standing.

Job Duties/Responsibilities

• Payment Integrity Strategy & Program Leadership
  • Develop, recommend, and lead execution of the multi-year Payment Integrity strategy and capability roadmap.
  • Own delivery of the approved Payment Integrity financial plan and validated savings commitments.
  • Set the strategic direction for evolving Payment Integrity from retrospective recovery toward prospective prevention.
  • Establish and govern the enterprise Payment Integrity operating model, decision rights, policies, and control framework.
  • Establish the executive performance framework for Payment Integrity.
• Vendor Portfolio & Sourcing Strategy
  • Set the strategic direction for the Payment Integrity delivery model.
  • Lead the Payment Integrity sourcing and commercial strategy.
  • Establish governance, performance standards, economic expectations, and escalation framework for the Payment Integrity vendor portfolio.
  • Drive portfolio optimization across internal and external Payment Integrity capabilities.
• Prepay & Postpay Program Ownership
  • Provide executive oversight of the enterprise prepayment integrity portfolio.
  • Set the strategy, investment priorities, and performance expectations for postpayment audit and recovery capabilities.
  • Provide strategic oversight of Coordination of Benefits and Subrogation capabilities.
  • Establish executive accountability for Payment Integrity compliance and control effectiveness.
• Analytics, Technology & Innovation
  • Define the Payment Integrity data, measurement, and analytics strategy.
  • Establish executive sponsorship and cross-functional accountability with Technology, Configuration, Data, and Claims Operations.
  • Define strategic Payment Integrity use cases and business requirements for AI, machine learning, automation, and emerging technologies.
  • Establish and govern a continuous Payment Integrity opportunity portfolio.
• Provider Experience & Cross-Functional Partnership
  • Establish the enterprise Payment Integrity provider-impact strategy and governance standards.
  • Serve as the senior Payment Integrity partner to Network Management and Contracting.
  • Establish executive-level operating agreements, decision rights, escalation protocols, and closed-loop accountability.
  • Provide executive leadership across Claims Operations, Finance, Medical Economics, and Compliance.
• Team Building & Leadership
  • Design and scale the Payment Integrity organization, leadership structure, workforce strategy, succession pipeline, and specialized capabilities.
  • Build a high-performing leadership culture characterized by enterprise accountability.
  • Develop leadership capability and succession depth across the Payment Integrity organization.
• Governance & Executive Reporting
  • Provide the Senior Vice President, Claims & Payment Integrity with transparent executive reporting.
  • Establish management accountability for effective Payment Integrity controls.
  • Serve as the executive escalation point for material Payment Integrity performance issues.

Qualifications

• 12+ years of progressive experience in healthcare Payment Integrity, claims operations, or a closely related function.
• Health plan (payer) experience is required.
• Demonstrated success setting strategy for and leading a multi-vendor Payment Integrity portfolio.
• Deep working knowledge of both prepay and postpay disciplines.
• Strong command of reimbursement methodology and coding standards.
• Track record of delivering measurable, validated savings.
• Demonstrated executive presence and influence.
• Proven ability to lead through other leaders.

Requirements

• Bachelor's degree in business, healthcare administration, finance, or a related field.

Benefits

• Pay Range: $227,952.00 - $341,928.00.
• Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.

Company Description

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail.

We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve.

Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them.