Vice President – Payment Integrity

Role Overview

• 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.

Tech Stack

• SQL

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.