Assistant Vice President designing and delivering automation solutions for client reporting in financial services. Collaborating across global teams and ensuring robust governance and compliance in implementation.
About the role
- VP of Payment Integrity overseeing the strategic vision and execution of payment integrity initiatives in healthcare. Leading audit functions and team development in a hybrid role.
Responsibilities
- Establish Payment Integrity strategy as key member of Cost Stewardship leadership team, partnering with Performance and Affordability teams to optimize healthcare value
- Present strategic initiatives and operational results to Board and C-suite stakeholders
- Direct pre-pay and post-pay audit programs, recovery operations, and provider-facing activities across all claim types
- Manage large-scale service provider relationships and optimize audit performance delivery
- Deploy AI/ML solutions and advanced analytics for payment accuracy and competitive advantage
- Design enterprise measurement frameworks with KPIs tracking audit effectiveness and recovery performance
- Build high-performing teams through strategic talent acquisition, succession planning, and performance management
- Lead large-scale organizational change initiatives across matrixed healthcare payer environment
Requirements
- Bachelor's degree, MBA or relevant Master’s degree strongly preferred
- 5-7 years of direct Payment Integrity leadership experience in a healthcare payer environment with responsibility for audit programs, payment validation, and recovery operations
- Minimum of 8-10 years of experience in business process design, improvement, and transformation within healthcare payment environments
- Minimum of 12-15 years of progressive leadership experience in Healthcare Payment Integrity, Health Plan Claims, Health Plan Operations or related Healthcare management or an equivalent combination of education and experience.
- Industry certifications such as CPC, CPMA, CFE, or equivalent strongly preferred
- Comprehensive knowledge of medical coding (CPT, ICD-10, HCPCS), billing practices, reimbursement methodologies, and claims adjudication across professional, institutional, and pharmacy claims
- Proficiency with SQL, claims processing systems, predictive modeling, and statistical analysis; demonstrated success implementing AI/ML solutions in payment integrity environments
- Experience with fraud/waste/abuse detection, COB and subrogation, CMS program integrity requirements, and regulatory compliance
- Exceptional executive presence with ability to set enterprise-wide strategic vision and influence across matrixed organizations
- Outstanding communication skills across all organizational levels, including Board and C-suite presentations
- Proven ability to identify systemic payment inefficiencies, architect comprehensive solutions, and drive consensus among diverse stakeholders
- Track record building and developing high-performing leadership teams with specialized expertise.
Benefits
- Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
- Annual employer contribution to a health savings account.
- Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
- Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
- Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
- Award-winning wellness programs that reward you for participation.
- Employee Assistance Fund for those in need.
- Commute and parking benefits.
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