Director, Payment Integrity Strategy
A
Abacus InsightsHealthcare SaaS
Remote USFull-TimeDirector
Salary not disclosed
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Job Details
- Experience
- 10+ years
Requirements
- Bachelor’s degree in a related field (e.g., healthcare administration, business, analytics, or similar) or equivalent work experience
- 10+ years of experience in healthcare payer environments with deep expertise in payment integrity, claims analytics, overpayment identification, recovery, and FWA concepts
- Prior experience in healthcare technology, analytics platforms, or data‑enabled services
- Deep hands-on experience in pre-pay, claim audit/complex claim review, and medical coding/auditing
- Strong understanding of CMS and state-level regulatory policies and guidelines
- Strong understanding of payer operations and how payment integrity strategies translate into measurable financial and operational outcomes
- Able to apply business logic and subject matter expertise to translate payment integrity data sources into pre-pay and post-pay payment integrity solutions
- Experience partnering with Product, Engineering, Analytics, Sales, and Operations teams in a data‑driven technology or SaaS environment
- Strong communication and presentation skills
- Strategic mindset, intellectual curiosity, and comfort operating in a fast‑paced, growth‑oriented organization
Responsibilities
- Act as a strategic leader for payment integrity across Abacus, shaping internal approaches to pre‑pay, post‑pay, recovery, and FWA‑related use cases
- Partner closely with Product, Engineering, Analytics, and Delivery teams to guide the design and evolution of payment integrity‑related capabilities, workflows, and analytical approaches
- Translate complex payment integrity findings, data patterns, and industry practices into clear insights, narratives, and recommendations for internal stakeholders and leadership
- Review and guide analytical methodologies to ensure accuracy, relevance, and alignment with payer operational realities
- Contribute to internal frameworks, playbooks, and documentation that enable consistent, scalable payment integrity practices across teams
- Serve as a thought partner to senior leaders on industry trends, regulatory considerations, and emerging payment integrity strategies
- Support internal enablement by sharing expertise, best practices, and lessons learned to raise organizational fluency in payment integrity
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