Explore high-impact Director of Payment Integrity jobs and lead the critical function that safeguards financial accuracy in healthcare. A Director of Payment Integrity is a senior strategic leader responsible for overseeing all activities that ensure correct payment of medical and pharmacy claims. This profession sits at the intersection of finance, operations, and compliance, with a core mission to eliminate fraud, waste, and abuse while ensuring regulatory adherence and optimizing cost containment for healthcare payers like insurance companies. Professionals in these jobs are ultimately accountable for ensuring that every dollar paid out for member care is appropriate, contractual, and error-free. Typical responsibilities for a Director of Payment Integrity are comprehensive and leadership-focused. They develop and execute the enterprise-wide payment integrity strategy, aligning it with organizational financial goals. This involves leading teams that conduct pre-payment and post-payment audits, manage recovery operations, and perform investigative functions. A significant part of the role is establishing strong governance and controls, often through cross-functional committees, to oversee policies and procedures. Directors in this field also manage vendor partnerships for audit and technology solutions, driving innovation and efficiency. They are tasked with implementing advanced analytics and automation to enhance program effectiveness, and they consistently monitor key performance indicators (KPIs) to track savings, recovery rates, and process improvements. Building, mentoring, and leading a high-performing team is a fundamental duty, as is serving as the organizational expert on payment integrity matters both internally and with external industry bodies. The typical skills and requirements for these leadership jobs are extensive. Candidates generally need a bachelor’s degree in business, healthcare administration, or a related field, with an advanced degree often preferred. A deep background (often 7-10+ years) in payment integrity, claims adjudication, or special investigation units (SIU) within healthcare is essential, with several years in a management capacity. Expertise in healthcare coding (ICD, CPT, HCPCS), claims processing systems, and data analysis tools is crucial. The role demands advanced strategic thinking, financial acumen for forecasting savings and ROI, and superior project management skills. Strong negotiation, relationship management, and communication abilities are required to influence stakeholders and manage vendors. A proven track record in driving operational excellence, process improvement (like Lean or Six Sigma), and change management is highly valued, as is a thorough understanding of the regulatory landscape governing healthcare payments. For professionals seeking to shape the financial integrity of healthcare, Director of Payment Integrity jobs offer a challenging and rewarding career path at the executive level.
