Director, Payment Integrity Strategy & Operations

Harris Health; Houston (TX); On-site; USD 140,000 - 190,000; Full time

Job summary

Community Health Choice, Inc. seeks a Director of Payment Integrity Strategy and Operations to lead and optimize PI programs, improving payment accuracy and member affordability. This role partners with Health Care, Finance, and external payer organizations to drive innovative PI strategies.

You will set governance for reimbursement policies, develop business cases, and manage cross-functional programs, dashboards, and KPIs to report performance to executives.

Qualifications

• Bachelor's degree and 10 years of experience in reimbursement policy, provider reimbursement, and/or strategic or product development.
• Direct health plan experience required.
• Experience with business case development, financial and market analysis and/or process redesign.

Responsibilities

• Manages day-to-day PI operations, ensuring execution of process improvements and program redesigns.
• Oversees team performance, implements internal evaluations, and coordinates with vendors and solution partners.
• Guides the development of new PI models and reimbursement engagement strategies.
• Develops and drives the overall PI strategy, aligning cost of care initiatives with enterprise goals.
• Sets SMART goals, leads ideation and vetting processes, and establishes KPIs to monitor success.
• Partners with actuarial and finance teams to develop business cases and monitor financial outcomes.
• Applies project management frameworks (e.g., RACI) to manage cross-functional initiatives.
• Drives organizational change, executes strategic roadmaps, and aligns milestones to business goals.
• Designs dashboards and reporting tools to track program performance for executives.
• Leads evaluations and aligns department metrics with corporate objectives.
• Leads development and management of reimbursement policies and governance.
• Communicates updates, solicits feedback, and documents approvals.

Skills

Leadership

Attention to Detail

Problem Analysis

Customer Oriented

Strategic Planning

Change Management

Cross-functional collaboration

Financial analysis

Education

Bachelor's degree

Job description

Community Health Choice, Inc. seeks a Director of Payment Integrity Strategy and Operations to lead and optimize PI programs, improving payment accuracy and member affordability. This role partners with Health Care, Finance, and external payer organizations to drive innovative PI strategies.

You will set governance for reimbursement policies, develop business cases, and manage cross-functional programs, dashboards, and KPIs to report performance to executives.