Alignment Health
Alignment Health is dedicated to providing comprehensive care for Medicare members, emphasizing the needs of seniors, the chronically ill, and those who are frail. With a mission to transform senior healthcare, Alignment Health leverages a tailored care model and advanced technology to deliver high-quality, low-cost healthcare services. Their 24/7 concierge care team collaborates with trusted local providers to ensure that every member receives personalized care, reflecting the company's commitment to treating all members as valued family members.
Medicare Advantage • Accountable care organization • Population health management • Medicare
AVP, Payment Integrity
March 7
Alignment Health
Alignment Health is dedicated to providing comprehensive care for Medicare members, emphasizing the needs of seniors, the chronically ill, and those who are frail. With a mission to transform senior healthcare, Alignment Health leverages a tailored care model and advanced technology to deliver high-quality, low-cost healthcare services. Their 24/7 concierge care team collaborates with trusted local providers to ensure that every member receives personalized care, reflecting the company's commitment to treating all members as valued family members.
Medicare Advantage • Accountable care organization • Population health management • Medicare
📋 Description
• The Associate Vice President, Payment Integrity will be responsible for overseeing all aspects of the payment integrity functions. • Ensure the accurate and efficient processing of claims, protecting the financial integrity of the organization. • Lead a cross-functional team to manage key areas such as pre-payment editing, subrogation, and compliance with SOX requirements. • Drive initiatives to improve payment accuracy and minimize financial risk. • Oversee both internal and vendor performance to achieve key cost containment objectives. • Create and lead the organization’s Payment Policy Committee to ensure alignment with corporate objectives.
🎯 Requirements
• At least 10 years of experience in healthcare payment integrity, audit, or related fields with at least 5 years in a leadership role. • Management of pre-payment editing, claims auditing, subrogation, credit balance management, and SOX compliance. • Oversight of vendor performance, with a focus on managing relationships and ensuring cost-effective service delivery. • Creating and leading cross-functional committees or teams, particularly related to policy development and governance. • Strong experience with data analytics, reporting tools, and financial testing processes. • Proven track record of and developing large teams and managing cross-functional projects.
🏖️ Benefits
• Equal Opportunity/Affirmative Action Employer • Opportunities for growth and innovation
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