AVP, Payor Collaboration and Interoperability

Vice President, Payor Collaboration And Interoperability

Ensemble Health Partners is seeking a seasoned Vice President, Payor Collaboration and Interoperability to lead a new strategic function focused on transforming payer-provider collaboration. This executive will be responsible for forging partnerships that reduce administrative waste, improve interoperability, and ensure patients receive the right care in the right setting at the highest quality.

The ideal candidate will bring extensive experience within major health insurance organizations, with a strong understanding of payer operations, data systems, reimbursement policy, and cross-functional collaboration across claims, utilization management, and network operations. This leader will apply that payer expertise to build durable, mutually beneficial partnerships between Ensemble and its payer counterparts.

Strategic Leadership

Develop and lead Ensemble's payer collaboration strategy focused on administrative simplification, data transparency, and friction reduction.

Design frameworks for long-term payer-provider collaboration, emphasizing shared savings, operational efficiency, and aligned incentives.

Drive interoperability initiatives that enable real-time data exchange and automation across pre-authorization, eligibility, and claims processing using FHIR, TEFCA, and X12 standards.

Ensure Ensemble's approach aligns with CMS and NCQA interoperability requirements, as well as broader national initiatives such as CAQH CORE.

Operational Execution

Build joint operating models with payer partners, including governance structures, accountability mechanisms, and performance metrics.

Work with technology and data teams to integrate payer data into Ensemble's workflow and analytics platforms to drive denial prevention, payment accuracy, and quality improvement.

Leverage payer insights to develop predictive and preventive solutions that improve patient access and care coordination.

Serve as the executive sponsor for payer-driven innovation pilots and joint process redesign initiatives.

Relationship and Stakeholder Management

Act as the primary relationship owner for senior payer executives, fostering trust-based collaboration and problem-solving.

Represent Ensemble in national payer and policy forums on interoperability and administrative simplification.

Partner with provider clients and Ensemble's operations and technology teams to align payer strategies with revenue cycle optimization goals.

Translate successful collaborations into scalable, technology-enabled models for broader client adoption.

Qualifications

15+ years of leadership experience in major health insurance or managed care organizations (e.g., national or regional payers, PBMs, or utilization management firms).

Deep expertise in payer operations, claims administration, utilization management, reimbursement policy, and interoperability standards (FHIR, HL7, X12, APIs).

Demonstrated success leading payer-provider partnerships or joint innovation initiatives that achieved measurable administrative and cost efficiency gains.

Strong understanding of CMS regulations, value-based care models, and network performance improvement.

Proven ability to navigate complex stakeholder environments and align payer and provider incentives.

Bachelor's degree required; Master's degree in Health Administration, Business, or Public Policy preferred.

Leadership Attributes

Payer Strategist : Brings firsthand understanding of payer systems, incentives, and operational levers.

Bridge Builder : Able to translate payer priorities into shared outcomes for providers and patients.

Innovator : Applies modern technology and data interoperability to streamline administrative processes.

Outcome-Driven Operator : Moves quickly from strategic design to measurable impact.

Join an award-winning company

Five-time winner of "Best in KLAS" 2020-2022, 2024-2025

Black Book Research's Top Revenue Cycle Management Outsourcing Solution 2021-2024

22 Healthcare Financial Management Association (HFMA) MAP Awards for High Performance in Revenue Cycle 2019-2024

Leader in Everest Group's RCM Operations PEAK Matrix Assessment 2024

Clarivate Healthcare Business Insights (HBI) Revenue Cycle Awards for strong performance 2020, 2022-2023

Energage Top Workplaces USA 2022-2024

Fortune Media Best Workplaces in Healthcare 2024

Monster Top Workplace for Remote Work 2024

Great Place to Work certified 2023-2024

• Innovation
• Work-Life Flexibility
• Leadership
• Purpose + Values

Bottom line, we believe in empowering people and giving them the tools and resources needed to thrive. A few of those include :

Ensemble Health Partners is an equal employment opportunity employer. It is our policy not to discriminate against any applicant or employee based on race, color, sex, sexual orientation, gender, gender identity, religion, national origin, age, disability, military or veteran status, genetic information or any other basis protected by applicable federal, state, or local laws. Ensemble Health Partners also prohibits harassment of applicants or employees based on any of these protected categories.

Ensemble Health Partners provides reasonable accommodations to qualified individuals with disabilities in accordance with the Americans with Disabilities Act and applicable state and local law. If you require accommodation in the application process, please contact TA@ensemblehp.com.

This posting addresses state specific requirements to provide pay transparency. Compensation decisions consider many job-related factors, including but not limited to geographic location; knowledge; skills; relevant experience; education; licensure; internal equity; time in position. A candidate entry rate of pay does not typically fall at the minimum or maximum of the role's range.