Vice President, Payment Integrity

Our Promise
Through skill-building, leadership development and philanthropic opportunities, we provide opportunities to build communities and grow your career, surrounded by diverse colleagues with high ethical standards.

Functional Competencies:

Vendor Monitoring & Audit Program Development

• Lead the strategic design and implementation of enterprise-wide monitoring programs for gold carded vendors, ensuring alignment with clinical, financial, and compliance objectives.
• Oversee monthly trend analyses and targeted audits to proactively identify performance deviations and risk areas.
• Partner with clinical leadership to prioritize audit focus areas using predictive analytics and data-driven insights.
• Provide executive oversight of documentation review and chart chase processes to ensure audit integrity and regulatory compliance.

Cost & Risk Analysis

• Direct high-level cost trending analyses for high-risk procedure codes across dental and vision services, identifying opportunities for cost containment and quality improvement.
• Translate complex financial data into strategic recommendations for clinical and operational leaders.
• Develop and deploy targeted audit strategies informed by utilization patterns, financial impact, and risk exposure.
• Lead post-audit strategic planning, including provider education, financial recoupment, and fraud/waste/abuse escalation protocols.

Cross-Functional Coordination

• Serve as the executive liaison to internal stakeholders, driving collaboration and execution of audit-related initiatives.
• Foster a culture of transparency, continuous improvement, and shared ownership of payment integrity outcomes.
• Facilitate monthly cross-departmental meetings to ensure alignment and execution of audit-related actions.

Vendor Oversight & Payment Integrity

• Provide strategic oversight of external vendors supporting payment integrity, ensuring performance metrics, contractual obligations, and audit recommendations are met.
• Evaluate vendor-generated insights and coordinate operational deployment of post-audit recoupment strategies.
• Maintain a forward-looking roadmap for audit edits (pre- and post-payment), including stakeholder engagement and change management planning.

Reporting & Performance Tracking

• Oversee the development of executive dashboards and reporting frameworks to monitor initiative progress, financial impact, and vendor performance.
• Deliver high-impact insights and strategic updates to senior leadership, enabling data-informed decision-making and resource allocation.

Provider Agreement Analysis

• Lead financial evaluations of provider rate schedules to assess value relative to premium payments and market benchmarks.
• Recommend strategic modifications to provider agreements based on cost-benefit analysis, network adequacy, and alternative provider availability.

• Collaborate with contracting and network teams to ensure alignment with organizational goals and member access standards.

Core Competencies:

Strategic Analytical Leadership

• Demonstrates advanced analytical acumen to interpret complex healthcare data, uncover systemic trends, and translate insights into strategic initiatives that drive financial performance, operational efficiency, and clinical alignment.

Audit & Compliance Governance

• Brings deep expertise in healthcare audit frameworks and payment integrity protocols, including post-audit processes and fraud, waste, and abuse (FWA) mitigation. Leads governance efforts to ensure regulatory compliance and risk management across vendor and internal operations.

Vendor Strategy & Performance Management

• Proven ability to lead strategic vendor partnerships, including contract negotiation, performance oversight, and alignment with organizational goals. Drives innovation and accountability in vendor-supported payment integrity programs.

Technology-Driven Decision Support

• Leverages advanced data visualization and reporting tools to build scalable monitoring systems and executive dashboards. Translates technical outputs into actionable intelligence for senior leadership and cross-functional teams.

Behavioral Competencies:

• Collegiality: building strong relationships on company-wide, approachable, and helpful, ability to mentor and support team growth.
• Initiative: readiness to lead or take action to achieve goals.
• Communicative: ability to relay issues, concepts, and ideas to others easily orally and in writing.
• Member-focused: going above and beyond to make our members feel seen, valued, and appreciated.
• Detail-oriented and thorough: managing and completing details of assignments without too much oversight.
• Flexible and responsive: managing new demands, changes, and situations.
• Critical Thinking: effectively troubleshoot complex issues, problem solve and multi-task.
• Integrity & responsibility: acting with a clear sense of ownership for actions, decisions and to keep information confidential when required.
• Collaborative: ability to represent your own interests while being fair to those representing other or competing ideas in search of a workable solution for all parties.

Minimum Qualifications:

• Bachelor's degree in finance, Healthcare Administration, Business, Data Analytics, or a related field
• 10+ years of experience in healthcare finance, vendor management, or payment integrity
• Strong analytical skills with experience in cost trending, audit coordination, or claims analysis
• Proven track record of managing complex vendor relationships and leading cross-functional initiatives
• Familiarity with healthcare coding systems (e.g., CPT, HCPCS) and provider reimbursement models

Preferred Qualifications:

• Master's degree in a relevant field
• Certifications such as:
  • Certified Healthcare Financial Professional (CHFP)
  • Certified Fraud Examiner (CFE)

FLSA Status: Salary/Exempt

National Salary Range: $200,000 - $300,000/year, commensurate with experience.

Bonus Eligible: Annual Incentive Plan (AIP)

How to stay safe:

Avesis is aware of fraudulent activity by individuals falsely representing themselves as Avesis recruiters. In some instances, these individuals may even contact applicants with a job offer letter, ask applicants to make purchases (i.e., a laptop or gift cards) from a designated vendor, have applicants fill out W-2 forms, or ask that applicants ship or send packages of goods to the company.

Avesis would never make such requests to applicants at any time throughout our job application process. We also would never ask applicants for personal information, such as passport numbers, bank account numbers, or social security numbers, during process. Our recruitment process takes place by phone and via trusted business communication platform (i.e., Zoom, Webex, Microsoft Teams, etc.). Any emails from Avesis recruiters will come from a verified email address ending in @Avesis.com.

We urge all applicants to exercise caution. If something feels off about your interactions, we encourage you to suspend or cease communications. If you are unsure of the legitimacy of a communication you have received, please reach out to ITsupport@Avesis.com.

To learn more about protecting yourself from fraudulent activity, please refer to this article link (https://consumer.ftc.gov/articles/how-avoid-scam). If you believe you were a victim of fraudulent activity, please contact your local authorities or file a complaint (Link: https://reportfraud.ftc.gov/#/) with the Federal Trade Commission. Avesis is not responsible for any claims, losses, damages, or expenses resulting from unaffiliated individuals of the company or their fraudulent activity.

We Offer

• Meaningful and challenging work opportunities to accelerate innovation in a secure and compliant way.
• Competitive compensation package.
• Excellent medical, dental, supplemental health, life and vision coverage for you and your dependents with no wait period.
• Life and disability insurance.
• A great 401(k) with company match.
• Tuition assistance, paid parental leave and backup family care.
• Dynamic, modern work environments that promote collaboration and creativity to develop and empower talent.
• Flexible time off, dress code, and work location policies to balance your work and life in the ways that suit you best.
• Employee Resource Groups that advocate for inclusion and diversity in all that we do.
• Social responsibility in all aspects of our work. We volunteer within our local communities, create educational alliances with colleges, drive a variety of initiatives in sustainability.

Equal Employment Opportunity

At Avsis, We See You. We celebrate differences and are building a culture of inclusivity and diversity. We are proud to be an Equal Employment Opportunity employer that considers all qualified applicants and does not discriminate against any person based on ancestry, age, citizenship, color, creed, disability, familial status, gender, gender expression, gender identity, marital status, military or veteran status, national origin, race, religion, sexual orientation, or any other characteristic. At Avsis, we believe that, to operate at the peak of excellence, our workforce needs to represent a rich mixture of diverse people, all focused on providing a world-class experience for our clients. We focus on recruiting, training and retaining those individuals that share similar goals. Come Dare to be Different at Avsis, where We See You!