Vice President, Payment Integrity

alignmenthealthcare; Orange (CA); On-site; USD 190,000 - 260,000; Full time

Job summary

Alignment Health seeks a Vice President of Payment Integrity to lead enterprise strategy, build a high-performing team, and optimize the mix of internal capabilities and vendor partnerships across prepay and postpay programs.

The role focuses on evolving the Payment Integrity ecosystem, improving first-pass payment accuracy, and protecting provider relationships, member experience, and regulatory standing. Strong payer-side expertise is required.

Qualifications

• Payer-side Payment Integrity expertise
• Technical and data-driven mindset
• Strong financial and strategic acumen
• Executive presence to influence leaders across multiple functions

Responsibilities

• Develop and lead the multi-year Payment Integrity strategy and roadmap.
• Own the financial plan and validated savings commitments.
• Shift from retrospective recovery to prospective prevention and first-pass payment accuracy.
• Establish governance, policies, and control framework for Payment Integrity.

Job description

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

The Vice President, Payment Integrity serves as the senior executive accountable for Alignment Health's enterprise Payment Integrity function and its contribution to payment accuracy, affordability, and medical cost performance. This leader will develop and lead execution of the Payment Integrity strategy, build and scale a high-performing organization, and establish the optimal mix of internal capabilities, technology, and strategic vendor partnerships across prepay and postpay programs.

Alignment's Payment Integrity program currently combines a small internal team with a large vendor footprint. The VP will provide executive leadership over the evolution of the Payment Integrity ecosystem, recommending build, buy, consolidate, insource, and retire decisions and holding internal leaders and external partners accountable for measurable, validated financial and operational outcomes. The VP will also lead the strategic shift from retrospective recovery toward prospective prevention and first-pass payment accuracy while protecting provider relationships, member experience, and regulatory standing.

This role requires payer-side Payment Integrity expertise, a technical and data-driven mindset, strong financial and strategic acumen, and the executive presence to influence and align leaders across Finance, Network, Configuration, Medical Economics, Technology, Claims Operations, and Compliance.

Job Duties/Responsibilities:

Payment Integrity Strategy & Program Leadership

• Develop, recommend, and lead execution of the multi-year Payment Integrity strategy and capability roadmap, establishing the priorities, investments, operating model, and performance expectations required to advance enterprise medical cost, affordability, and payment accuracy objectives.
• Own delivery of the approved Payment Integrity financial plan and validated savings commitments; recommend annual targets, investment requirements, opportunity priorities, and corrective actions in partnership with Finance and Medical Economics.
• Set the strategic direction for evolving Payment Integrity from retrospective recovery toward prospective prevention, establishing enterprise priorities that improve first-pass payment accuracy, reduce avoidable medical cost, and minimize administrative burden for Alignment and its providers.
• Establish and govern the enterprise Payment Integrity operating model, decision rights, policies, and control framework, including standards for concept approval, savings validation, provider impact, and program performance.
• Establish the executive performance framework for Payment Integrity, ensuring transparent measurement of validated net savings, financial return, program effectiveness, quality, provider impact, and operational performance and using those insights to drive investment and portfolio decisions.

Vendor Portfolio & Sourcing Strategy

• Set the strategic direction for the Payment Integrity delivery model, determining and recommending the optimal mix of internal capabilities, technology, and external partnerships based on financial return, strategic control, scalability, quality, and provider impact.
• Lead the Payment Integrity sourcing and commercial strategy, including evaluation and negotiation of strategic solutions and partnerships, and recommend material vendor selections and contractual commitments in accordance with enterprise financial and approval authorities.
• Establish the governance, performance standards, economic expectations, and escalation framework for the Payment Integrity vendor portfolio, holding internal leaders and strategic partners accountable for validated net value, quality, compliance, service performance, and provider impact.
• Drive portfolio optimization across internal and external Payment Integrity capabilities, eliminating redundant investment, conflicting concepts, and unnecessary provider abrasion while maximizing enterprise value and strategic alignment.

Prepay & Postpay Program Ownership

• Provide executive oversight of the enterprise prepayment integrity portfolio, ensuring clinical, coding, reimbursement, high-dollar, and complex-claim capabilities are prioritized and governed according to financial value, accuracy, scalability, compliance, and provider impact.
• Set the strategy, investment priorities, and performance expectations for postpayment audit and