Vice President, Payment Integrity

Alignment Health; United States; Remote; USD 250,000 - 450,000; Full time

Job summary

Alignment Health is seeking a Vice President of Payment Integrity to lead the enterprise strategy, governance, and execution of programs across prepay and postpay to improve payment accuracy, cost performance, and provider relationships.

The role requires payer-side expertise, a data-driven mindset, and the ability to influence leaders across Finance, Network, Technology, and Compliance. Strategic vendor partnerships and innovative use of technology are expected.

Qualifications

• Payer-side Payment Integrity expertise.
• Technical and data-driven mindset.
• Strong financial and strategic acumen.

Responsibilities

• Develop, recommend, and lead execution of the multi-year Payment Integrity strategy and capability roadmap.
• Own delivery of the approved Payment Integrity financial plan and validated savings commitments; set targets and investments.
• Shift from retrospective recovery toward prospective prevention and first-pass payment accuracy while protecting provider relationships and member experience.
• Establish and govern the enterprise Payment Integrity operating model, policies, and control framework.
• Establish the executive performance framework for Payment Integrity with transparent measurement of savings, return, and performance.

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 recovery capabilities, with accountability for validated financial yield, timeliness, defensibility, and conversion of retrospective findings into sustainable preventive controls.

• Provide strategic oversight of Coordination of Benefits and Subrogation capabilities, ensuring these programs are integrated into the broader Payment Integrity portfolio and deliver approved recovery, avoidance, compliance, and member/provider experience outcomes.

• Establish executive accountability for Payment Integrity compliance and control effectiveness, ensuring programs operate in accordance with CMS Medicare Advantage payment requirements, provider contractual obligations, applicable prompt-pay requirements, and enterprise policies, with timely escalation of material compliance or regulatory risk.

Analytics, Technology & Innovation

• Define the Payment Integrity data, measurement, and analytics strategy, establishing authoritative standards for savings attribution, opportunity prioritization, root-cause insight, financial validation, and executive performance transparency.

• Establish executive sponsorship and cross-functional accountability with Technology, Configuration, Data, and Claims Operations to translate Payment Integrity insights into sustainable claims configuration, reimbursement policy, and adjudication improvements that prevent payment errors upstream.

• Define strategic Payment Integrity use cases and business requirements for AI, machine learning, automation, and emerging technologies; sponsor pilots and recommend investments that demonstrate measurable value while maintaining appropriate standards for accuracy, explainability, controls, compliance, and provider experience.

• Establish and govern a continuous Payment Integrity opportunity portfolio that converts regulatory, coding, billing, provider, market, and industry intelligence into prioritized initiatives supported by clear business cases, investment decisions, and measurable outcomes.

Provider Experience & Cross-Functional Partnership

• Establish the enterprise Payment Integrity provider-impact strategy and governance standards, ensuring programs balance financial value with defensible policy, transparency, regulatory requirements, and sustainable provider relationships.

• Serve as the senior Payment Integrity partner to Network Management and Contracting, ensuring Payment Integrity strategies and policies align with provider contractual frameworks and leading resolution of material or systemic provider issues requiring executive intervention.

• Establish executive-level operating agreements, decision rights, escalation protocols, and closed-loop accountability with the Special Investigations Unit and Provider Disputes and Appeals organizations to ensure effective coordination while maintaining clear functional ownership.

• Provide executive leadership across Claims Operations, Finance, Medical Economics, and Compliance to establish authoritative Payment Integrity savings methodologies and ensure financial outcomes are validated, auditable, appropriately attributed, and reflected in enterprise financial reporting.

Team Building & Leadership

• Design and scale the Payment Integrity organization, leadership structure, workforce strategy, succession pipeline, and specialized capabilities required to execute the multi-year roadmap and deliver sustainable enterprise outcomes through accountable leaders.

• Build a high-performing leadership culture characterized by enterprise accountability, disciplined execution, financial stewardship, innovation, accuracy, and continuous improvement; establish clear performance expectations and hold leaders accountable for business outcomes.

• Develop leadership capability and succession depth across