Director Payment Integrity

Description

Calling all Esteemed Leaders!

Are you a strategic mastermind with a passion for healthcare? Do you thrive on navigating complex challenges and shaping the future of healthcare delivery? If so, then we have the perfect opportunity for you!

The Role

This position can be based in Portland, OR Seattle, WA or Irvine, CA. The Director of Payment Integrity (PI) is responsible for overseeing the strategy, execution, and optimization of enterprise-wide payment integrity initiatives. You will ensure accurate claims payment and reduce financial leakage, playing a critical leadership role in managing third-party vendors, guiding initiative discovery and implementation, and shaping the vision of the Payment Integrity Office.

What You'll Do?

• Strategic Leadership:
• Develop and lead the strategy for the Payment Integrity Office aligned with enterprise financial and operational goals.
• Partner with executive leadership to align PI initiatives with organizational priorities, compliance requirements, and growth strategies.
• Establish a roadmap for cost containment, waste reduction, and payment accuracy initiatives with annual savings targets of +$10 million.
• Direct a team of experts and analysts to support PI business initiatives, problem resolution, system enhancements, and configuration.
• Ensure initiatives are researched, communicated, delivered on time, and tracked for alignment with savings projections.
• Vendor Relationship Management:
• Lead all aspects of vendor relationships related to claims editing, including operationalizing new vendor solutions.
• Negotiate and manage contracts, performance metrics, SLAs, and vendor accountability frameworks.
• Ensure vendors deliver measurable value and align with the organization's evolving needs.
• Initiative Discovery & Development:
• Identify and evaluate opportunities to improve payment accuracy and operational efficiency across the claims lifecycle.
• Leverage data analytics, industry trends, and intelligence to propose and prioritize new PI initiatives.
• Collaborate with medical policy, analytics, compliance, IT, and claims teams to assess feasibility and impact.
• Oversee the development and evaluation of PI initiative performance, including process evaluation and financial measures.
• Execution & Delivery:
• Lead cross-functional teams in executing PI initiatives from planning through implementation.
• Ensure initiatives are delivered on time, within scope, and achieve expected financial outcomes.
• Oversee reporting, dashboards, and KPIs to monitor and communicate progress.
• Governance & Oversight:
• Build and manage a PI governance framework including initiative intake, prioritization, and tracking.
• Maintain compliance with federal and state regulatory requirements impacting claims and PI.
• Provide regular updates and strategic insights to senior leadership and governance committees.

What You'll Bring?

• Educational Background: Bachelor's Degree in Business, Health Administration, Finance, or related field.
• Experience: 5 years in healthcare payment integrity, claims operations, or healthcare consulting.
• Leadership: 5 years managing teams and/or vendor relationships.
• Industry Knowledge: Deep knowledge of claims editing, medical policies, cost containment methodologies, and regulatory requirements.
• Technical Skills: Experience with CMS reimbursement methodologies, provider contracts, and medical coding practices.
• Strategic Planning: Proven ability to lead strategic planning and large-scale operational initiatives.
• Analytical Skills: Strong analytical, financial modeling, and decision-making skills.
• Communication: Excellent communication and relationship management skills.

Why Join Us?

• Make a Real Difference: Be part of an organization transforming healthcare and improving lives.
• Unleash Your Potential: Enjoy autonomy and support to bring innovative ideas to life.
• Work with the Best: Collaborate with talented professionals passionate about their work.
• Thrive in a Dynamic Environment: Embrace the challenges and rewards of a fast-paced, evolving industry.

Ready to Shape the Future of Healthcare?

If you're a visionary leader with a passion for healthcare, we encourage you to apply! Join our team and help us create a healthier future for all.

About Providence

At Providence, our strength lies in Our Promise of "Know me, care for me, ease my way." Working at our family of organizations means that regardless of your role, we'll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.

The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits.

Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act."

About the Team

Providence Shared Services is a service line within Providence that provides a variety of functional and system support services for our family of organizations across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. We are focused on supporting our Mission by delivering a robust foundation of services and sharing of specialized expertise.

Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement.

Requsition ID: 390845

Company: Providence Jobs

Job Category: Financial Transactions

Job Function: Health Plans Services

Job Schedule: Full time

Job Shift: Day

Career Track: Leadership

Department: 5018 HCS MEDICAL MANAGEMENT OR REGION

Address: OR Portland 4400 NE Halsey St

Work Location: Providence Office Park Portland Bldg 1-Portland

Workplace Type: Remote

Pay Range: $65.83 - $103.93

The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.