Director, Payment Integrity Strategy & Audit Lead

Blue Cross & Blue Shield of Rhode Island; Providence (RI); Hybrid; USD 116,900 - 187,100; Full time

Benefits offered by this job

Tuition reimbursement

Bonuses and investment plans

Health, dental, and vision insurance

Paid time off

Job summary

Blue Cross & Blue Shield of Rhode Island is seeking a senior leader to oversee the Payment Integrity program, directing audits and vendor relationships while ensuring financial integrity and regulatory compliance. The role collaborates with executives to drive performance and members’ care value.

The position offers hybrid work options and a competitive compensation package, with a focus on developing and expanding the department within the organization.

Qualifications

• Five to seven years of management experience.
• Five to seven years of payment integrity or medical billing operations experience.
• Strong working knowledge of Microsoft Excel and Access.
• Knowledge of healthcare financing, provider contracts, and related information systems.

Responsibilities

• Oversee and direct programs that create a strong Payment Integrity program and vendor relationships.
• Manage daily operations of the payment integrity department and audits.
• Foster relationships with providers and coordinate paid claim audits.
• Develop work plans to manage resources and meet audit timelines.
• Ensure accurate financial reporting and data interpretation for health plan decisions.
• Support executive leadership with strategic initiatives and training programs.

Skills

Management experience

Leadership

Communication skills

Excel

Access

Project coordination

Negotiation

Education

Bachelor's degree in business

Tools

Excel

Access

Job description

Blue Cross & Blue Shield of Rhode Island is seeking a senior leader to oversee the Payment Integrity program, directing audits and vendor relationships while ensuring financial integrity and regulatory compliance. The role collaborates with executives to drive performance and members’ care value.

The position offers hybrid work options and a competitive compensation package, with a focus on developing and expanding the department within the organization.