VP, Payment Integrity

Blue Cross NC

. Provide strategic direction and centralized leadership for provider payment integrity and reimbursement policy functions .

Posted 9/23/2026full-timeUnited StatesLeadWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Payment Integrity strategy development, claims accuracy, and reimbursement methodologies, while effectively leading high-performing teams and fostering cross-functional collaboration to drive operational excellence.

Highest-signal resume keywords

Payment Integrity Strategy DevelopmentHealthcare Reimbursement MethodologiesClaims AdministrationFinancial AnalysisLeadership in Healthcare Operations

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Payment AccuracyClaims IntegrityCoding ValidationRecovery OperationsAdvanced AnalyticsOperational ExcellenceKPI EstablishmentGovernance FrameworksData Translation into StrategiesRegulatory Requirements

Soft Skills

Executive PresenceCommunication SkillsInfluencing StakeholdersTeam DevelopmentContinuous Improvement

Tools & Technologies

Automation TechnologiesAnalytics ToolsPerformance Metrics Systems

Industry Keywords

Healthcare EconomicsClaims OperationsRevenue CycleProvider EducationMulti-Vendor Management

About the role

Key responsibilities & impact

Provide strategic direction and centralized leadership for provider payment integrity and reimbursement policy functions
Lead prepayment clinical and coding requirements and post-payment recoupment efforts
Promote accuracy in claims payment and correct coding to drive savings
Lead strategies for reimbursement policy development, claims editing, post-payment analytics and recoupment, provider education, coordination of benefits, and innovative payment integrity programs
Oversee enterprise payment integrity initiatives that advance affordability, payment accuracy, and operational excellence
Assess the Payment Integrity ecosystem, prioritize high-value opportunities, and establish KPIs
Develop and execute an enterprise-wide Payment Integrity strategy
Lead programs focused on payment accuracy, claims integrity, coding validation, recovery operations, and coordination of benefits
Leverage advanced analytics, automation, and emerging technologies to identify opportunities, reduce waste, and improve outcomes
Establish performance metrics, governance frameworks, and reporting to measure business impact and value realization
Partner with provider-facing teams to balance payment accuracy with a positive provider experience
Manage a high-performing multi-vendor portfolio by enforcing SLAs, optimizing fee structures, and minimizing provider abrasion
Advise executive leadership on payment integrity trends, risks, opportunities, and industry best practices
Build and develop a high-performing team while fostering innovation, accountability, and continuous improvement
Partner across Finance, Medical Economics, Provider Network Management, Clinical Operations, Technology, Compliance, and Legal

Requirements

What you’ll need

Bachelor's degree in Business, Healthcare Administration, Finance, Public Health, or a related field
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
Exceptional executive presence, communication skills, and ability to influence across diverse stakeholder groups