01Overview
About the position
Candidates who reside within 50 miles of the following locations may be asked to work in person three days per week: Bloomfield, CT, Chattanooga, TN, Denver, CO, St Louis, MO, or Scottsdale, AZ. Payment Integrity - Program Management Senior Advisor This role provides enterpriselevel leadership for prepayment vendor operations within the Payment Integrity organization. The Senior Program Advisor is accountable for vendor operations, contracting partnership, and lifecycle management to ensure vendors are selected, structured, and managed to deliver sustainable value at scale. Role Purpose Owns endtoend prepayment vendor operations, contracting partnerships, and lifecycle management for prepay vendor programs. Ensures alignment of vendor capabilities with reimbursement methodologies, business goals, and regulatory expectations while minimizing financial, legal, and operational risk.
Responsibilities
Lead vendor intake, evaluation, onboarding, contracting, performance oversight, and lifecycle management for prepay programs
Serve as the primary business partner to Legal for vendor agreements, risk terms, compliance provisions, and governance controls
Apply deep Payment Integrity domain expertise to assess vendor edit models, analytics capabilities, and operational fit
Leverage reimbursement methodology and claims knowledge to guide vendor selection and usecase alignment
Define, document, and maintain standardized vendor option sets by edit type and business need
Partner with Product, Analytics, Operations, Finance, Compliance, and IT to support vendor strategy decisions
Provide thought leadership on vendor risk, scalability, and longterm sustainability aligned to the Integrity Select roadmap
Establishes clear accountability and ownership for vendor decisions and associated risk
Enables consistent, scalable, and standardized vendor selection across Payment Integrity programs
Reduces legal, financial, and operational exposure through disciplined governance
Ensures vendor operations align to longterm enterprise and Integrity Select strategies
Requirements
Bachelors degree or higher strongly preferred or equivalent work experience required
10+ years of healthcare payer experience
7+ years of direct Payment Integrity vendor experience required
Extensive experience with claim editing operations and reimbursement methodologies required
Demonstrated experience with provider and vendor contracting, including riskbased and performancebased terms
Broad Payment Integrity expertise including data mining, analyticsdriven recovery, DRG audits, claim editing, subrogation, COB, and prepay/postpay programs required
Proven ability to partner across Legal, Compliance, Contracting, Finance, Claims, Sales/Marketing, Analytics, and IT required
Strong strategic, analytical, and independent decisionmaking capability in a matrixed organization
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
Nice-to-haves
Advanced experience interpreting and applying legal concepts, policies, and healthcare payer regulations
Prior ownership of enterprise vendor oversight models and internal lifecycle governance
Experience defining enterprisewide vendor standards, operating models, or governance frameworks
Background in financial and operational risk management related to vendor programs
Demonstrated ability to influence executivelevel and senior leadership stakeholders
Familiarity with federal and state regulatory requirements impacting Payment Integrity programs
This role operates with a high degree of autonomy and is expected to exercise sound judgment in alignment with enterprise policies and regulatory requirements.
Benefits
Starting on day one of your employment, youll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs.
We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays.
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