VP, Payment Integrity

12+ years of progressive leadership experience in payment integrity, healthcare economics, claims operations, health plan operations, revenue cycle, or a related healthcare function.

Proven success leading large-scale strategic initiatives and high-performing teams within a payer, health plan, consulting organization, or healthcare enterprise.

Deep knowledge of healthcare reimbursement methodologies, claims administration, payment accuracy, and regulatory requirements.

Strong financial, analytical, and business acumen with the ability to translate complex data into actionable strategies.

To provide strategic direction and centralized leadership to the provider payment integrity and reimbursement policy functions inclusive of prepayment clinical and coding requirements and post payment recoupment, to promote accuracy in claims payment and correct coding to drive savings.

Leads strategies for reimbursement policy development, claims editing, post payment analytics and recoupment efforts, provider education, coordination of benefits and development of new innovative programs to drive downstream cost savings for the organization.

Has direct or matrixed accountability for SIU integration with or other payment integrity activities.

Ensures alignment and compliance with industry standards and accountable for cost of care initiatives and assigned targets to provide affordable care to members.

Blue Cross NC is seeking a strategic and innovative Vice President, Payment Integrity to lead the vision, strategy, and execution of enterprise payment integrity programs that advance affordability, payment accuracy, and operational excellence.

As a key member of the leadership team, this executive will oversee initiatives designed to prevent, identify, and recover inaccurate healthcare payments while enhancing provider experience and supporting sustainable healthcare costs.