Strategic Leader, Payment Integrity & Operations

Community Health Choice; Houston (TX); On-site; USD 180,000 - 240,000; Full time

Job summary

Community Health Choice is seeking a Director of Payment Integrity Strategy and Operations to lead the design, execution, and optimization of PI programs, aligning reimbursement policies with enterprise goals and improving member affordability.

You will partner with Health Care, Finance, actuarial, and external payers to develop models, dashboards, and governance, while guiding cross-functional teams through strategic roadmaps and performance management.

Qualifications

• Bachelor’s degree and 10 years of experience in reimbursement policy, provider reimbursement, and/or strategic or product development.
• Must have direct health plan experience.
• 7 years leadership experience, leading people and/or complex cross-divisional projects or programs.

Responsibilities

• Oversee day-to-day Payment Integrity operations and drive process improvements.
• Lead development of PI models and reimbursement engagement strategies.
• Set SMART goals, KPIs, and oversee cross-functional initiatives with actuarial and finance.
• Design dashboards and reporting tools to track program performance for executive leadership.
• Liaise with enterprise and external payer organizations to align strategy and cost of care efforts.

Skills

Strategic leadership

Program management

Performance measurement

Cross-functional collaboration

Education

Bachelor's degree

Job description

Community Health Choice is seeking a Director of Payment Integrity Strategy and Operations to lead the design, execution, and optimization of PI programs, aligning reimbursement policies with enterprise goals and improving member affordability.

You will partner with Health Care, Finance, actuarial, and external payers to develop models, dashboards, and governance, while guiding cross-functional teams through strategic roadmaps and performance management.