Vice President Payment Integrity

Cambia Health Solutions

Tacoma, WA

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JOB DETAILS

JOB TYPE

Full-time, Employee

SKILLS

Adjudication, Artificial Intelligence (AI), Auditing, Billing, Business Administration, Certified Financial Examiner (CFE), Certified Professional Coder (CPC), Claims Processing, Communication Skills, Content Management Systems (CMS), Current Procedural Terminology (CPT), Customer Experience, Health Economics, Health Plan, Healthcare, Healthcare Common Procedure Coding System (HCPCS), Healthcare Management, ICD-10, Leadership, Matrix Management, Medical Coding, Operational Audit, Operational Strategy, Operations Planning, Organizational Skills, Performance Metrics, Performance Tuning/Optimization, Pharmacy, Predictive Modeling, Process Improvement, Regulatory Compliance, Regulatory Requirements, Reimbursement, SQL (Structured Query Language), Statistics, Stewardship, Strategic Planning, Subrogation, Systems Maintenance, Team Building

ADDITIONAL COMPENSATION

see description

LOCATION

Tacoma, WA

POSTED

30+ days ago

----Job Description----
Vice President of Payment Integrity

Oregon, Washington, Idaho or Utah (Hybrid)

Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.

Who We Are Looking For:

Every day, Cambia's dedicated team is living our mission to make health care easier and lives better. As a member of the Customer Experience and Operations team, our VP of Payment Integrity provides executive leadership and strategic oversight of the Payment Integrity organization within Cost Stewardship. This position drives enterprise-wide strategic vision and execution across post-pay and pre-pay audit functions, provider-facing operations and advance analytics capabilities - all in service of creating an economically sustainable health care system.

As a people leader, you are willing to learn and grow, understanding that leadership is a craft that is continuously honed as you support your team and the lives that depend upon us.

What You Bring to Cambia:

Qualifications:

* Bachelor's degree, MBA or relevant Master's degree strongly preferred
* 5-7 years of experience of direct Payment Integrity leadership experience in a healthcare payer environment with responsibility for audit programs, payment validation, and recovery operations
* Minimum of 8-10 years of experience in business process design, improvement, and transformation within healthcare payment environments and a minimum of 12-15 years of progressive leadership experience in Healthcare Payment Integrity, Health Plan Claims, Health Plan Operations or related Healthcare management or an equivalent combination of education and experience.
* Industry certifications such as CPC, CPMA, CFE, or equivalent strongly preferred

Skills and Attributes:

Technical Expertise

* Medical & Claims: Comprehensive knowledge of medical coding (CPT, ICD-10, HCPCS), billing practices, reimbursement methodologies, and claims adjudication across professional, institutional, and pharmacy claims
* Analytics & Technology: Proficiency with SQL, claims processing systems, predictive modeling, and statistical analysis; demonstrated success implementing AI/ML solutions in payment integrity environments
* Specialized Knowledge: Experience with fraud/waste/abuse detection, COB and subrogation, CMS program integrity requirements, and regulatory compliance

Leadership Capabilities

* Exceptional executive presence with ability to set enterprise-wide strategic vision and influence across matrixed organizations
* Outstanding communication skills across all organizational levels, including Board and C-suite presentations
* Proven ability to identify systemic payment inefficiencies, architect comprehensive solutions, and drive consensus among diverse stakeholders
* Track record building and developing high-performing leadership teams with specialized expertise

What You Will Do at Cambia:

Enterprise Strategy & Cost Stewardship

* Establish Payment Integrity strategy as key member of Cost Stewardship leadership team, partnering with Performance and Affordability teams to optimize healthcare value
* Present strategic initiatives and operational results to Board and C-suite stakeholders
Comprehensive Audit Operations

* Direct pre-pay and post-pay audit programs, recovery operations, and provider-facing activities across all claim types
* Manage large-scale service provider relationships and optimize audit performance delivery
Technology & Analytics

* Deploy AI/ML solutions and advanced analytics for payment accuracy and competitive advantage
* Design enterprise measurement frameworks with KPIs tracking audit effectiveness and recovery performance
Organizational Leadership

* Build high-performing teams through strategic talen
To view the full job description, click here

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About the Company

Cambia Health Solutions

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