Vice president, payment integrity

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

The Vice President, Payment Integrity serves as the senior executive accountable for Alignment Health's enterprise Payment Integrity function and its contribution to payment accuracy, affordability, and medical cost performance. This leader will develop and lead execution of the Payment Integrity strategy, build and scale a high-performing organization, and establish the optimal mix of internal capabilities, technology, and strategic vendor partnerships across prepay and postpay programs.

Alignment's Payment Integrity program currently combines a small internal team with a large vendor footprint. The VP will provide executive leadership over the evolution of the Payment Integrity ecosystem, recommending build, buy, consolidate, insource, and retire decisions and holding internal leaders and external partners accountable for measurable, validated financial and operational outcomes. The VP will also lead the strategic shift from retrospective recovery toward prospective prevention and first-pass payment accuracy while protecting provider relationships, member experience, and regulatory standing.

This role requires payer-side Payment Integrity expertise, a technical and data-driven mindset, strong financial and strategic acumen, and the executive presence to influence and align leaders across Finance, Network, Configuration, Medical Economics, Technology, Claims Operations, and Compliance.

Job Duties/Responsibilities:

• Payment Integrity Strategy & Program Leadership
• Vendor Portfolio & Sourcing Strategy
• Prepay & Postpay Program Ownership
• Analytics, Technology & Innovation
• Provider Experience & Cross-Functional Partnership
• Team Building & Leadership
• Governance & Executive Reporting

Job Requirements:

EXPERIENCE

Required:

• 12+ years of progressive experience in healthcare Payment Integrity, claims operations, or a closely related function, including 7+ years in progressively responsible leadership roles with accountability for complex functions, leaders, financial outcomes, and enterprise initiatives.
• Health plan (payer) experience is required, including direct leadership of Payment Integrity programs inside a payer organization.
• Demonstrated success setting strategy for and leading a multi-vendor Payment Integrity portfolio, including vendor selection, contract and pricing negotiation, portfolio optimization, financial accountability, and executive-level performance governance.
• Deep working knowledge of both prepay and postpay disciplines: clinical and coding edits, DRG validation, itemized bill review, data mining, COB, and subrogation.
• Strong command of reimbursement methodology and coding standards, including MS-DRG, APC, fee schedules, NCCI, CPT/HCPCS, and ICD-10.
• Track record of delivering measurable, validated savings while actively managing provider abrasion.
• Demonstrated executive presence and influence, with experience advising senior executives, translating complex financial and operational issues into enterprise decisions, and building alignment across highly matrixed organizations.
• Demonstrated experience establishing strategy, operating models, governance, performance frameworks, and investment priorities for a complex healthcare function.
• Proven ability to lead through other leaders and hold cross-functional stakeholders accountable for enterprise outcomes without relying solely on direct reporting authority.

Preferred:

• Medicare Advantage experience, including CMS payment policy (NCD/LCD) and MA-specific regulatory requirements.
• Payment Integrity vendor-side experience (for example Optum, Cotiviti, Machinify, Zelis, or HealthEdge) in addition to payer experience.
• Experience building a Payment Integrity function from a small base, or insourcing previously outsourced programs.
• Experience with Facets or a comparable core claims administration platform.
• Experience sponsoring, evaluating, and driving value realization from AI/ML-driven Payment Integrity solutions.
• Experience leading significant Payment Integrity transformation, operating-model redesign, vendor consolidation, insourcing, or capability modernization initiatives.

EDUCATION

Required:

• Bachelor's degree in business, healthcare administration, finance, or a related field, or an equivalent combination of education and experience.

Preferred:

• Master's degree.

SPECIALIZED SKILLS

Strategic leadership. Enterprise-minded executive capable of translating medical cost, affordability, payment accuracy, and organizational priorities into a multi-year Payment Integrity strategy and making disciplined build, buy, partner, and investment decisions.

Executive decision-making. Demonstrates sound judgment in balancing financial opportunity, operational complexity, regulatory requirements, provider impact, technology investment, and enterprise risk.

Technical and analytical acumen. Fluent in healthcare claims, reimbursement, data, analytics, and Payment Integrity methodologies; able to challenge assumptions, evaluate complex models and vendor methodologies, and translate technical findings into executive decisions. Hands-on coding is not required.

Financial acumen. Strong command of medical cost economics, savings validation, forecasting, ROI, investment prioritization, vendor economics, and financial performance management, with the ability to connect Payment Integrity outcomes to broader enterprise affordability and medical cost objectives.

Strategic vendor leadership. Experienced in developing sourcing strategies, negotiating complex commercial arrangements, evaluating strategic partnerships, and holding vendors accountable for measurable financial, quality, compliance, and provider-experience outcomes.

Enterprise influence. Operates effectively across organizational boundaries, influences senior executives and functional leaders, resolves competing priorities, and builds alignment around complex Payment Integrity, financial, provider, and operational decisions.

Organizational leadership. Builds scalable organizations and leadership teams, establishes clear decision rights and accountability, develops succession depth, and creates a culture of disciplined execution and continuous improvement.

Transformation leadership. Leads complex transformation by establishing a clear strategic vision, mobilizing cross-functional stakeholders, prioritizing investments, and ensuring sustainable adoption and measurable business outcomes.

Mission focus. Brings a senior-first mindset to executive decision-making, balancing affordability and payment accuracy objectives with provider relationships, member experience, regulatory obligations, and Alignment Health's broader mission.

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.

The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Pay Range:

$227,952.00 - $341,928.00

Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email careers@ahcusa.com.