VP, Payment Integrity

Overview 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 & Execution   Own the end-to-end payment integrity business strategy, operating model, and execution roadmap across the HealthEdge ecosystem   Accountable for portfolio performance, business growth, and achievement of financial objectives associated with payment integrity solutions  Define and execute a multi-year vision and transformation roadmap for payment integrity capabilities across the HealthEdge platform  Drive innovation strategies leveraging AI, analytics, automation, and emerging healthcare technologies  Lead business case development and investment strategies for new capabilities, partnerships, and market opportunities   Influence pricing, commercialization strategy, and go-to-market alignment for payment integrity offerings  Product & Cross-Functional Partnership   Establish payment integrity roadmap priorities in alignment with product, technology, and market strategies  Serve as the enterprise authority on payment integrity strategy, claims accuracy, payment policy, and cost containment innovation  Drive enterprise analytics strategy and insight-driven innovation for payment integrity capabilities in partnership with Data teams  Ensure alignment across teams to deliver integrated, client-centric solutions  Client Impact & Value Realization   Drive executive-level client engagement strategies to accelerate adoption, value realization, retention, and expansion of payment integrity solutions  Build and maintain strategic relationships with executive stakeholders across payer organizations and industry partners  Serve as HealthEdge’s executive spokesperson and thought leader for payment integrity strategy and innovation   Bring forward client insights to inform product development and continuous improvement   Own expansion opportunities through demonstrated client value and outcomes  Team Leadership & Organizational Effectiveness   Build and evolve a payment integrity organization capable of supporting long-term business growth and market expansion   Establish clear operating rhythms, performance expectations, and accountability across the team   Drive succession planning, leadership development, and organizational design strategies across the function  Build team capability in payment integrity methodologies, analytics, and client delivery   Foster a culture of collaboration, continuous improvement, and results orientation  Data, Analytics & Operational Rigor   Establish enterprise governance frameworks, operating standards, and compliance strategies for payment integrity solutions and methodologies  Drive enterprise decision-making through advanced analytics, performance insights, and predictive payment integrity strategies  Partner with Data and Analytics teams to ensure accuracy, consistency, and rigor in payment integrity outputs   Support development of analytical methodologies and validation approaches aligned with industry standards   Enterprise Leadership & Governance   Drive alignment across Product, Technology, Sales, Operations, Finance, and Client Success leaders to ensure execution of payment integrity priorities   Influence enterprise investment decisions, operating models, and strategic planning activities related to payment integrity capabilities   Establish governance frameworks, executive reporting structures, and performance metrics to measure business impact and operational effectiveness   Partner with executive leadership to identify acquisition, partnership, and market expansion opportunities   Represent payment integrity priorities and business performance within executive leadership forums  MINIMUM REQUIRED QUALIFICATIONS   Education & Experience   Bachelor’s degree required; advanced degree (MBA, MHA, MPH) preferred   10–15+ years of experience in healthcare, payment integrity, claims operations, or related field   7+ years of senior leadership experience   Experience working within healthcare technology, payer organizations, or related services environments  Domain Expertise   Strong expertise in payment integrity methodologies, including claims editing, payment policy, and cost containment strategies   Solid understanding of healthcare reimbursement models, payer operations, and regulatory considerations   Experience working with healthcare data, analytics, and technology-enabled solutions   Familiarity with CMS guidelines and broader regulatory frameworks preferred  Leadership & Execution   Demonstrated success leading enterprise-scale healthcare or payment integrity transformation initiatives   Proven ability to influence executive stakeholders, enterprise strategy, and investment prioritization decisions   Experience owning business outcomes, growth strategies, and operational performance within complex matrixed organizations   Recognized industry leader with experience representing organizations externally through conferences, advisory boards, publications, or analyst engagements   Experience leading through organizational scale, transformation, and c