Payment Integrity Principal

A company is looking for a Payment Integrity Principal to oversee payment integrity strategy and automation across its platform.

Key Responsibilities

Serve as a senior business owner for implementing program domain logic across the platform

Ensure cohesive interaction between rule logic, automation, and AI-driven capabilities for scalable outcomes

Analyze claims data to identify patterns and contribute to the development of payment integrity policies

Required Qualifications

Bachelor's degree in healthcare, business, information systems, data analytics, or a related field, or equivalent experience

Active professional credential in Coding Review, Coordination of Benefits, or Data Mining

12+ years of experience in healthcare payment integrity or closely related fields

7+ years of experience in analyzing or designing solutions for improper payments

Proven experience in translating domain expertise into scalable logic and automation frameworks