Director of Payment Integrity & Compliance

MyTruAdvantage; Columbus (IN); Hybrid; USD 110,000 - 150,000; Full time

Job summary

SIHO is seeking a Director of Payment Integrity to lead QA, Grievances & Appeals, and Fraud, Waste & Abuse teams in Columbus, IN. This role shapes strategy and directly supervises day-to-day operations, partnering with multiple departments and external stakeholders.

The ideal candidate holds a B.S. or equivalent, 3–5 years in managed care, deep regulatory knowledge (CMS, state requirements), and proven people leadership, with strong Excel and communication skills to drive compliance and

Qualifications

• B.S. degree or equivalent healthcare operations experience.
• 3–5 years in a managed care environment.
• Strong knowledge of CMS and state regulations.

Responsibilities

• Directly supervise QA, Grievances & Appeals, and Fraud, Waste & Abuse teams.
• Translate regulatory requirements into practical, actionable process changes.
• Continuously monitor and improve grievances and appeals processes for compliance.
• Lead data analysis to identify trends and drive improvements.
• Collaborate with vendors and external stakeholders; interface with SIHO leadership.

Skills

Leadership

Regulatory knowledge

Data analysis

Communication

Project management

Education

Bachelor's degree

Tools

Excel

PowerPoint

Outlook

HSP claims system

Job description

SIHO is seeking a Director of Payment Integrity to lead QA, Grievances & Appeals, and Fraud, Waste & Abuse teams in Columbus, IN. This role shapes strategy and directly supervises day-to-day operations, partnering with multiple departments and external stakeholders.

The ideal candidate holds a B.S. or equivalent, 3–5 years in managed care, deep regulatory knowledge (CMS, state requirements), and proven people leadership, with strong Excel and communication skills to drive compliance and