Head of Payment Integrity Strategy & Operations

Community Health Choice, Inc.; Houston (TX); Hybrid; USD 150,000 - 210,000; Full time

Job summary

Community Health Choice, Inc. is seeking a Director of Payment Integrity Strategy and Operations to lead design, execution, and optimization of PI programs and to improve payment accuracy and affordability for Members.

This role partners with Health Care, Finance, and external payer organizations to identify and implement innovative PI strategies, align cost of care goals, and drive performance across the program.

Qualifications

• Bachelor’s degree and 10 years of experience in reimbursement policy, provider reimbursement, and/or strategic or product development required.
• Must have direct health plan experience required.
• Experience with business case development, financial and market analysis and/or process redesign.
• Experience with Payment Integrity products and solutions required.
• Experience with strategy frameworks/roadmaps and change management preferred.
• 7 years leadership experience, leading people and/or complex cross-divisional projects or programs required.
• History of high performance and leadership in a matrixed organization preferred.

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 strategy for Payment Integrity, aligning cost of care initiatives with enterprise goals.
• Sets SMART goals, leads ideation and vetting processes, and establishes KPIs to monitor and evaluate success.
• Partners with actuarial and finance teams to develop business cases and monitor financial outcomes.
• Applies project management frameworks to manage cross-functional initiatives.
• Drives organizational change, facilitates execution of strategic roadmaps, and aligns project milestones to overall business goals.
• Designs dashboards and reporting tools to track program performance and communicate insights to executive leadership.
• Leads internal and external evaluations and aligns department metrics with corporate objectives and financial strategies.
• Establishes and facilitates Reimbursement Policy Governance Committees for Commercial and Medicare lines of business.
• Communicates updates, solicits feedback, and documents approvals and concerns.
• Serves as a liaison and thought leader for PI across the enterprise and with external organizations.

Skills

Strategic planning

Leadership

Financial analysis

Vendor management

Education

Bachelor’s degree and 10 years of experience in reimbursement policy/provider reimbursement/strategic or product development

Job description

Community Health Choice, Inc. is seeking a Director of Payment Integrity Strategy and Operations to lead design, execution, and optimization of PI programs and to improve payment accuracy and affordability for Members.

This role partners with Health Care, Finance, and external payer organizations to identify and implement innovative PI strategies, align cost of care goals, and drive performance across the program.