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. The Vice President will partner across Finance, Medical Economics, Provider Network Management, Clinical Operations, Technology, Compliance, and Legal to drive measurable impact through analytics, automation, and process innovation.
What You'll Do
What You'll Bring
Why Blue Cross NC
At Blue Cross NC, we're committed to making healthcare better and more affordable for the people we serve. This role offers a unique opportunity to shape the future of payment integrity, influence enterprise strategy, and drive meaningful impact on affordability, operational performance, and healthcare outcomes across North Carolina and beyond.
Join us and help transform healthcare through innovation, integrity, and strategic leadership.
VP, Payment Integrity • Durham, NC, United States
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