Director, Payment Integrity & Compliance

Zim Directory; Columbus (IN); On-site; USD 120,000 - 160,000; Full time

Job summary

SIHO is seeking a Director of Payment Integrity to lead the QA, Grievances & Appeals, and Fraud, Waste & Abuse teams. You will set strategy, oversee daily operations, and interface with internal stakeholders and external regulators.

You will translate CMS and state requirements into practical processes, monitor performance, and drive cost-saving improvements while maintaining high professional standards across multiple priorities.

Qualifications

• Bachelor’s degree or equivalent in healthcare operation.
• 3–5 years of experience in a managed care environment.
• Strong understanding of federal and state regulations related to grievances and appeals.

Responsibilities

• Directly supervise the QA, Grievances & Appeals, and FWA teams, including day-to-day oversight and performance management.
• Interpret federal/state regulations and translate into actionable process changes.
• Monitor and improve grievances and appeals processes for CMS and state compliance.
• Lead data analysis in Excel to identify trends and insights.
• Coordinate with vendors and internal teams on data transfers and issue escalation.
• Interact with customers and respond to external inquiries from CMS and regulators.

Skills

Regulatory compliance

People leadership

Communication skills

Healthcare operations

Excel data analysis

Education

Bachelor's degree in healthcare operation

Tools

HSP claims system

Job description

SIHO is seeking a Director of Payment Integrity to lead the QA, Grievances & Appeals, and Fraud, Waste & Abuse teams. You will set strategy, oversee daily operations, and interface with internal stakeholders and external regulators.

You will translate CMS and state requirements into practical processes, monitor performance, and drive cost-saving improvements while maintaining high professional standards across multiple priorities.