VP, Payment Integrity
Durham, NC · On-site
Leads strategies for reimbursement policy development, claims editing, post payment analytics and ... Has direct or matrixed accountability for SIU integration with or other payment integrity ...
Durham, NC · On-site
Leads strategies for reimbursement policy development, claims editing, post payment analytics and ... Has direct or matrixed accountability for SIU integration with or other payment integrity ...
Durham, NC · On-site
Leads strategies for reimbursement policy development, claims editing, post payment analytics and ... Has direct or matrixed accountability for SIU integration with or other payment integrity ...
Analyze and reconcile Payment Integrity program payments, billings, vendor invoices, and related financial transactions to ensure accuracy and compliance. * Validate vendor invoices and payments ...
Analyze and reconcile Payment Integrity program payments, billings, vendor invoices, and related financial transactions to ensure accuracy and compliance. * Validate vendor invoices and payments ...
Payment Integrity delivers value through pre-pay and post-pay editing, advanced claim analytics, fraud, waste and abuse prevention, and recovery optimization-all supported by a rapidly evolving data ...
Payment Integrity delivers value through pre-pay and post-pay editing, advanced claim analytics, fraud, waste and abuse prevention, and recovery optimization-all supported by a rapidly evolving data ...
BerryDunn is seeking a Payment Integrity Subject Matter Expert (SME) to support Hawaii Med-QUEST ... Analyze claims, provider, member, utilization, financial, and operational data to identify high ...
BerryDunn is seeking a Payment Integrity Subject Matter Expert (SME) to support Hawaii Med-QUEST ... Analyze claims, provider, member, utilization, financial, and operational data to identify high ...
Payment Integrity delivers value through pre-pay and post-pay editing, advanced claim analytics, fraud, waste and abuse prevention, and recovery optimization-all supported by a rapidly evolving data ...
Payment Integrity delivers value through pre-pay and post-pay editing, advanced claim analytics, fraud, waste and abuse prevention, and recovery optimization-all supported by a rapidly evolving data ...
Overview BerryDunn is seeking a Payment Integrity Subject Matter Expert (SME) to support Hawaii Med ... Analyze claims, provider, member, utilization, financial, and operational data to identify high ...
Overview BerryDunn is seeking a Payment Integrity Subject Matter Expert (SME) to support Hawaii Med ... Analyze claims, provider, member, utilization, financial, and operational data to identify high ...
Payment Integrity delivers value through pre-pay and post-pay editing, advanced claim analytics, fraud, waste and abuse prevention, and recovery optimization-all supported by a rapidly evolving data ...
Payment Integrity delivers value through pre-pay and post-pay editing, advanced claim analytics, fraud, waste and abuse prevention, and recovery optimization-all supported by a rapidly evolving data ...
Payment Integrity delivers value through pre-pay and post-pay editing, advanced claim analytics, fraud, waste and abuse prevention, and recovery optimization-all supported by a rapidly evolving data ...
Payment Integrity delivers value through pre-pay and post-pay editing, advanced claim analytics, fraud, waste and abuse prevention, and recovery optimization-all supported by a rapidly evolving data ...
Payment Integrity delivers value through pre-pay and post-pay editing, advanced claim analytics, fraud, waste and abuse prevention, and recovery optimization-all supported by a rapidly evolving data ...
Payment Integrity delivers value through pre-pay and post-pay editing, advanced claim analytics, fraud, waste and abuse prevention, and recovery optimization-all supported by a rapidly evolving data ...
Columbia, MO · On-site +1
$87K - $157K/yr
Responsible for driving program results through audit oversight, trend analysis, and the development of standardized review criteria and best practices. * Lead and oversee Payment Integrity ...
Columbia, MO · On-site +1
$87K - $157K/yr
Responsible for driving program results through audit oversight, trend analysis, and the development of standardized review criteria and best practices. * Lead and oversee Payment Integrity ...
Providence, RI · On-site +1
$116K - $187K/yr
Manage daily operations of the payment integrity department; lead the strategic program expansion ... of analysis and enhances their technology literacy. * Manage the oversight, direction and ...
Providence, RI · On-site +1
$116K - $187K/yr
Manage daily operations of the payment integrity department; lead the strategic program expansion ... of analysis and enhances their technology literacy. * Manage the oversight, direction and ...
Analyze and reconcile Payment Integrity program payments, billings, vendor invoices, and related financial transactions to ensure accuracy and compliance. * Validate vendor invoices and payments ...
Analyze and reconcile Payment Integrity program payments, billings, vendor invoices, and related financial transactions to ensure accuracy and compliance. * Validate vendor invoices and payments ...
Saint Louis, MO · On-site +1
$87K - $157K/yr
Responsible for driving program results through audit oversight, trend analysis, and the development of standardized review criteria and best practices. * Lead and oversee Payment Integrity ...
Saint Louis, MO · On-site +1
$87K - $157K/yr
Responsible for driving program results through audit oversight, trend analysis, and the development of standardized review criteria and best practices. * Lead and oversee Payment Integrity ...
Analyze and reconcile Payment Integrity program payments, billings, vendor invoices, and related financial transactions to ensure accuracy and compliance. * Validate vendor invoices and payments ...
Analyze and reconcile Payment Integrity program payments, billings, vendor invoices, and related financial transactions to ensure accuracy and compliance. * Validate vendor invoices and payments ...
Jefferson City, MO · On-site +1
$87K - $157K/yr
Responsible for driving program results through audit oversight, trend analysis, and the development of standardized review criteria and best practices. * Lead and oversee Payment Integrity ...
Jefferson City, MO · On-site +1
$87K - $157K/yr
Responsible for driving program results through audit oversight, trend analysis, and the development of standardized review criteria and best practices. * Lead and oversee Payment Integrity ...
Florissant, MO · On-site +1
$87K - $157K/yr
Responsible for driving program results through audit oversight, trend analysis, and the development of standardized review criteria and best practices. * Lead and oversee Payment Integrity ...
Florissant, MO · On-site +1
$87K - $157K/yr
Responsible for driving program results through audit oversight, trend analysis, and the development of standardized review criteria and best practices. * Lead and oversee Payment Integrity ...
Providence, RI · On-site
Manage daily operations of the payment integrity department; lead the strategic program expansion ... of analysis and enhances their technology literacy. * Manage the oversight, direction and ...
Providence, RI · On-site
Manage daily operations of the payment integrity department; lead the strategic program expansion ... of analysis and enhances their technology literacy. * Manage the oversight, direction and ...
Kansas City, MO · On-site +1
$87K - $157K/yr
Responsible for driving program results through audit oversight, trend analysis, and the development of standardized review criteria and best practices. * Lead and oversee Payment Integrity ...
Kansas City, MO · On-site +1
$87K - $157K/yr
Responsible for driving program results through audit oversight, trend analysis, and the development of standardized review criteria and best practices. * Lead and oversee Payment Integrity ...
Indianapolis, IN · On-site
$64K - $97K/yr
Business Analyst II - Payment Integrity Datamining Business Analyst II - Payment Integrity Datamining Location: This role requires associates to be in-office 1 - 2 days per week, fostering ...
Indianapolis, IN · On-site
$64K - $97K/yr
Business Analyst II - Payment Integrity Datamining Business Analyst II - Payment Integrity Datamining Location: This role requires associates to be in-office 1 - 2 days per week, fostering ...
Eden Prairie, MN · Remote
$87K - $110K/yr
The Senior Data Analyst supports Payment Integrity Operations through advanced data analyses that strengthen execution, standardization, and performance outcomes. The role delivers reliable reporting ...
New
Eden Prairie, MN · Remote
$87K - $110K/yr
The Senior Data Analyst supports Payment Integrity Operations through advanced data analyses that strengthen execution, standardization, and performance outcomes. The role delivers reliable reporting ...
New
$35K - $43.7K
2% of jobs
$43.7K - $52.5K
17% of jobs
$54.7K is the 25th percentile. Wages below this are outliers.
$52.5K - $61.2K
23% of jobs
The median wage is $65.9K / yr.
$61.2K - $69.9K
15% of jobs
$69.9K - $78.6K
13% of jobs
$83.7K is the 75th percentile. Wages above this are outliers.
$78.6K - $87.4K
9% of jobs
$87.4K - $96.1K
7% of jobs
$96.1K - $104.8K
4% of jobs
$104.8K - $113.5K
3% of jobs
$113.5K - $122.3K
4% of jobs
$122.3K - $131K
2% of jobs
$35K
$75.5K
$131K
| Aspect | Overnight Payment Integrity Analyst | Payment Operations Specialist |
|---|---|---|
| Credentials | Relevant certifications (e.g., CPA, CPA, or industry-specific certifications) | Similar certifications often required |
| Work Environment | Night shifts, data analysis, and transaction review | Day shifts, processing payments, customer service |
| Industry Usage | Financial services, banking, payments | Financial services, banking, payments |
| Search/Comparison Intent | Focus on payment accuracy, fraud detection, and transaction review | Focus on payment processing, customer support, and account management |
The Overnight Payment Integrity Analyst primarily focuses on reviewing and ensuring the accuracy of transactions during overnight hours, often involving fraud detection and data analysis. In contrast, the Payment Operations Specialist handles daily payment processing, customer inquiries, and account management. While both roles operate within the financial industry and may require similar certifications, their work hours and primary responsibilities differ significantly.
Full-time
Posted 6 days ago
7.8
Based on 13 frontline employees who took The Breakroom Quiz
191st of 306 rated insurance
Job Description
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.
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JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on https://bcbsnc.wd5.myworkdayjobs.com/en-US/BCBSNC. If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: HR.Staffing@BCBSNC.com.
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Insurance services
5,001 - 10,000 Employees
Durham, NC, US
1933