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 & ExecutionOwn the end-to-end payment integrity business strategy, operating model, and execution roadmap across the HealthEdge ecosystemAccountable for portfolio performance, business growth, and achievement of financial objectives associated with payment integrity solutionsDefine and execute a multi-year vision and transformation roadmap for payment integrity capabilities across the HealthEdge platformDrive innovation strategies leveraging AI, analytics, automation, and emerging healthcare technologiesLead business case development and investment strategies for new capabilities, partnerships, and market opportunitiesInfluence pricing, commercialization strategy, and go-to-market alignment for payment integrity offeringsProduct & Cross-Functional PartnershipEstablish payment integrity roadmap priorities in alignment with product, technology, and market strategiesServe as the enterprise authority on payment integrity strategy, claims accuracy, payment policy, and cost containment innovationDrive enterprise analytics strategy and insight-driven innovation for payment integrity capabilities in partnership with Data teamsEnsure alignment across teams to deliver integrated, client-centric solutionsClient Impact & Value RealizationDrive executive-level client engagement strategies to accelerate adoption, value realization, retention, and expansion of payment integrity solutionsBuild and maintain strategic relationships with executive stakeholders across payer organizations and industry partnersServe as HealthEdge’s executive spokesperson and thought leader for payment integrity strategy and innovationBring forward client insights to inform product development and continuous improvementOwn expansion opportunities through demonstrated client value and outcomesTeam Leadership & Organizational EffectivenessBuild and evolve a payment integrity organization capable of supporting long-term business growth and market expansionEstablish clear operating rhythms, performance expectations, and accountability across the teamDrive succession planning, leadership development, and organizational design strategies across the functionBuild team capability in payment integrity methodologies, analytics, and client deliveryFoster a culture of collaboration, continuous improvement, and results orientationData, Analytics & Operational RigorEstablish enterprise governance frameworks, operating standards, and compliance strategies for payment integrity solutions and methodologiesDrive enterprise decision-making through advanced analytics, performance insights, and predictive payment integrity strategiesPartner with Data and Analytics teams to ensure accuracy, consistency, and rigor in payment integrity outputsSupport development of analytical methodologies and validation approaches aligned with industry standardsEnterprise Leadership & GovernanceDrive alignment across Product, Technology, Sales, Operations, Finance, and Client Success leaders to ensure execution of payment integrity prioritiesInfluence enterprise investment decisions, operating models, and strategic planning activities related to payment integrity capabilitiesEstablish governance frameworks, executive reporting structures, and performance metrics to measure business impact and operational effectivenessPartner with executive leadership to identify acquisition, partnership, and market expansion opportunitiesRepresent payment integrity priorities and business performance within executive leadership forumsMINIMUM REQUIRED QUALIFICATIONSEducation & ExperienceBachelor’s degree required; advanced degree (MBA, MHA, MPH) preferred10–15+ years of experience in healthcare, payment integrity, claims operations, or related field7+ years of senior leadership experienceExperience working within healthcare technology, payer organizations, or related services environmentsDomain ExpertiseStrong expertise in payment integrity methodologies, including claims editing, payment policy, and cost containment strategiesSolid understanding of healthcare reimbursement models, payer operations, and regulatory considerationsExperience working with healthcare data, analytics, and technology-enabled solutionsFamiliarity with CMS guidelines and broader regulatory frameworks preferredLeadership & ExecutionDemonstrated success leading enterprise-scale healthcare or payment integrity transformation initiativesProven ability to influence executive stakeholders, enterprise strategy, and investment prioritization decisionsExperience owning business outcomes, growth strategies, and operational performance within complex matrixed organizationsRecognized industry leader with experience representing organizations externally through conferences, advisory boards, publications, or analyst engagementsExperience leading through organizational scale, transformation, and change management initiativesCommunication & InfluenceStrong communication
