Director Payment Integrity
Company: Providence Health & Services
Location: East Irvine
Posted on: October 30, 2025
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Job Description:
Calling all Esteemed Leaders! Are you a strategic mastermind
with a passion for healthcare? Do you thrive on navigating complex
challenges and shaping the future of healthcare delivery? If so,
then we have the perfect opportunity for you! The Role This
position can be based in Portland, OR Seattle, WA or Irvine, CA.
The Director of Payment Integrity (PI) is responsible for
overseeing the strategy, execution, and optimization of
enterprise-wide payment integrity initiatives. You will ensure
accurate claims payment and reduce financial leakage, playing a
critical leadership role in managing third-party vendors, guiding
initiative discovery and implementation, and shaping the vision of
the Payment Integrity Office. What You’ll Do? Strategic Leadership:
Develop and lead the strategy for the Payment Integrity Office
aligned with enterprise financial and operational goals. Partner
with executive leadership to align PI initiatives with
organizational priorities, compliance requirements, and growth
strategies. Establish a roadmap for cost containment, waste
reduction, and payment accuracy initiatives with annual savings
targets of $10 million. Direct a team of experts and analysts to
support PI business initiatives, problem resolution, system
enhancements, and configuration. Ensure initiatives are researched,
communicated, delivered on time, and tracked for alignment with
savings projections. Vendor Relationship Management: Lead all
aspects of vendor relationships related to claims editing,
including operationalizing new vendor solutions. Negotiate and
manage contracts, performance metrics, SLAs, and vendor
accountability frameworks. Ensure vendors deliver measurable value
and align with the organizations evolving needs. Initiative
Discovery & Development: Identify and evaluate opportunities to
improve payment accuracy and operational efficiency across the
claims lifecycle. Leverage data analytics, industry trends, and
intelligence to propose and prioritize new PI initiatives.
Collaborate with medical policy, analytics, compliance, IT, and
claims teams to assess feasibility and impact. Oversee the
development and evaluation of PI initiative performance, including
process evaluation and financial measures. Execution & Delivery:
Lead cross-functional teams in executing PI initiatives from
planning through implementation. Ensure initiatives are delivered
on time, within scope, and achieve expected financial outcomes.
Oversee reporting, dashboards, and KPIs to monitor and communicate
progress. Governance & Oversight: Build and manage a PI governance
framework including initiative intake, prioritization, and
tracking. Maintain compliance with federal and state regulatory
requirements impacting claims and PI. Provide regular updates and
strategic insights to senior leadership and governance committees.
What You’ll Bring? Educational Background: Bachelors Degree in
Business, Health Administration, Finance, or related field.
Experience: 5 years in healthcare payment integrity, claims
operations, or healthcare consulting. Leadership: 5 years managing
teams and/or vendor relationships. Industry Knowledge: Deep
knowledge of claims editing, medical policies, cost containment
methodologies, and regulatory requirements. Technical Skills:
Experience with CMS reimbursement methodologies, provider
contracts, and medical coding practices. Strategic Planning: Proven
ability to lead strategic planning and large-scale operational
initiatives. Analytical Skills: Strong analytical, financial
modeling, and decision-making skills. Communication: Excellent
communication and relationship management skills. Why Join Us? Make
a Real Difference: Be part of an organization transforming
healthcare and improving lives. Unleash Your Potential: Enjoy
autonomy and support to bring innovative ideas to life. Work with
the Best: Collaborate with talented professionals passionate about
their work. Thrive in a Dynamic Environment: Embrace the challenges
and rewards of a fast-paced, evolving industry. Ready to Shape the
Future of Healthcare? If youre a visionary leader with a passion
for healthcare, we encourage you to apply! Join our team and help
us create a healthier future for all. About Providence At
Providence, our strength lies in Our Promise of “Know me, care for
me, ease my way.” Working at our family of organizations means that
regardless of your role, we’ll walk alongside you in your career,
supporting you so you can support others. We provide best-in-class
benefits and we foster an inclusive workplace where diversity is
valued, and everyone is essential, heard and respected. Together,
our 120,000 caregivers (all employees) serve in over 50 hospitals,
over 1,000 clinics and a full range of health and social services
across Alaska, California, Montana, New Mexico, Oregon, Texas and
Washington. As a comprehensive health care organization, we are
serving more people, advancing best practices and continuing our
more than 100-year tradition of serving the poor and vulnerable.
Providence offers a comprehensive benefits package including a
retirement 401(k) Savings Plan with employer matching, health care
benefits (medical, dental, vision), life insurance, disability
insurance, time off benefits (paid parental leave, vacations,
holidays, health issues), voluntary benefits, well-being resources
and much more. About the Team Providence Shared Services is a
service line within Providence that provides a variety of
functional and system support services for our family of
organizations across Alaska, California, Montana, New Mexico,
Oregon, Texas and Washington. We are focused on supporting our
Mission by delivering a robust foundation of services and sharing
of specialized expertise. Providence is proud to be an Equal
Opportunity Employer. We are committed to the principle that every
workforce member has the right to work in surroundings that are
free from all forms of unlawful discrimination and harassment on
the basis of race, color, gender, disability, veteran, military
status, religion, age, creed, national origin, sexual identity or
expression, sexual orientation, marital status, genetic
information, or any other basis prohibited by local, state, or
federal law. We believe diversity makes us stronger, so we are
dedicated to shaping an inclusive workforce, learning from each
other, and creating equal opportunities for advancement. Pay Range:
$ 65.83 - $ 103.93 The amounts listed are the base pay range;
additional compensation may be available for this role, such as
shift differentials, standby/on-call, overtime, premiums, extra
shift incentives, or bonus opportunities.
Keywords: Providence Health & Services, Irvine , Director Payment Integrity, Accounting, Auditing , East Irvine, California
