Vice President, Payment Integrity (Remote - US)

This position is posted by Jobgether on behalf of Avesis, Incorporated. We are currently looking for a Vice President, Payment Integrity in United States.

This role offers an opportunity to lead enterprise-wide payment integrity initiatives, driving financial performance, operational efficiency, and regulatory compliance. The VP will oversee internal cross-functional teams and external vendor partnerships, leveraging data-driven insights to optimize vendor performance, mitigate fraud, waste, and abuse, and enhance audit and compliance processes. The position requires a visionary leader who combines financial acumen, clinical insight, and advanced analytics with strong communication skills to translate complex data into actionable strategies. This role provides the chance to influence senior leadership decisions, implement innovative programs, and deliver measurable impact in a dynamic healthcare environment.

Accountabilities

• Lead the strategic design and execution of enterprise-wide payment integrity programs, including the gold carded vendor monitoring initiative.
• Oversee vendor relationships, ensuring performance metrics, contractual obligations, and audit recommendations are met.
• Direct audits, post-audit recoupment, and compliance activities to safeguard organizational financial health.
• Conduct cost trending and risk analyses, providing actionable insights to guide operational and clinical decisions.
• Collaborate with clinical leadership to prioritize focus areas using predictive analytics and data-driven insights.
• Develop and maintain executive dashboards and reporting frameworks to monitor initiatives, vendor performance, and financial impact.
• Advise senior leadership on strategic initiatives, provider agreement optimization, and regulatory compliance.
• Foster cross-functional alignment and drive continuous improvement in payment integrity processes.

• Bachelor’s degree in Finance, Healthcare Administration, Business, Data Analytics, or related field required; Master’s preferred.
• 10+ years of experience in healthcare finance, vendor management, or payment integrity, with proven leadership of cross-functional teams.
• Strong analytical and strategic thinking skills with experience in cost trending, claims analysis, and audit coordination.
• Expertise in vendor oversight, contract optimization, and performance management.
• Familiarity with healthcare coding systems (e.g., CPT, HCPCS) and provider reimbursement models.
• Professional certifications such as CHFP or CFE preferred.
• Excellent communication, presentation, and mentoring skills to influence senior leadership and cross-functional teams.
• Ability to lead complex initiatives, manage competing priorities, and drive measurable results in a fast-paced environment.

• Competitive base salary with annual incentive plan.
• Comprehensive medical, dental, vision, life, and disability insurance with no waiting period.
• 401(k) plan with company match.
• Tuition assistance, paid parental leave, and backup family care.
• Flexible time off, modern work environments, and hybrid work arrangements where applicable.
• Employee Resource Groups promoting inclusion and diversity.
• Social responsibility programs, volunteer opportunities, and sustainability initiatives.
• Professional growth opportunities, leadership development, and skill-building programs.

Jobgether is a Talent Matching Platform that partners with companies worldwide to efficiently connect top talent with the right opportunities through AI-driven job matching.

When you apply, your profile goes through our AI-powered screening process designed to identify top talent efficiently and fairly:
🔍 Our AI evaluates your CV and LinkedIn profile thoroughly, analyzing your skills, experience, and achievements.
📊 It compares your profile to the job’s core requirements and past success factors to determine your match score.
🎯 Based on this analysis, we automatically shortlist the 3 candidates with the highest match to the role.
🧠 When necessary, our human team may perform an additional manual review to ensure no strong profile is missed.

The process is transparent, skills-based, and free of bias — focusing solely on your fit for the role. Once the shortlist is completed, we share it directly with the company that owns the job opening. The final decision and next steps (such as interviews or additional assessments) are then managed by their internal hiring team.

Thank you for your interest! 

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