Director, Payment Integrity at Altais Health Solutions – Remote

About Our Company

At Altais, we’re looking for bold and curious clinicians and innovators who share our passion for enabling better health care experiences and revolutionizing the healthcare system for physicians, advanced care providers, patients, and the clinical community. At Altais, we’re building breakthrough clinical support tools, technology, and services to let doctors do what they do best: care for people. We invite you to join our growing passionate team as we change the game for the future of healthcare and enable the experience that people need and deserve. Altais family of companies include Brown & Toland Physicians, Family Care Specialists and Altais Medical Groups.

About Your Team

Are you looking to work with a high performing, fast growing and dynamic Claims team? Altais and our subsidiaries, form one of the most recognized medical groups in California. We are 4,000+ physicians, working in over 40 cities in California, caring for more than 500,000 patients. If working in a mission driven organization supporting highly competent, hard-working, thoughtful clinicians who value good ideas and are passionate about reshaping healthcare excites you, then we are thrilled to welcome you to your new career.

About Your Work

The Director of Payment Integrity is responsible for leading the strategic planning, development, and execution of a comprehensive Payment Integrity program. Reporting to the Head of Claims, this role will focus on ensuring claims are paid accurately and appropriately, with a strong emphasis on identifying near-term opportunities to positively impact healthcare costs.

This leader will oversee the design and optimization of operational processes, establish procedural standards, and manage both internal teams and vendor relationships to ensure adherence to KPIs and SLAs. The role requires close collaboration with IT, vendors, and cross-functional business teams to drive continuous operational and technical improvements.

Key responsibilities include managing all pre- and post-payment integrity processes—such as correct coding, medical payment policy enforcement, overpayment recovery, subrogation, coordination of benefits (COB), and premium enhancements (e.g., ESRD, Medicare Secondary Payer). The Director will also provide leadership in automation initiatives aimed at reducing G&A costs and improving financial outcomes, while ensuring compliance with CMS and state regulatory requirements.

The ideal candidate will bring strong leadership, analytical, and project management skills, with experience in claims operations, payment integrity, and healthcare regulatory compliance. This role will also be responsible for presenting initiatives to executive leadership, overseeing performance monitoring, and ensuring timely and high-quality execution of all Payment Integrity activities.

You will focus on:

• This role is responsible for planning, developing, and implementing an overall Payment Integrity strategy and multi-year roadmap with a near term focus on near term opportunities to ensure claims payments are accurate and appropriately paid to have a positive in-year impact to healthcare costs
• Key duties include optimizing operational process designs, setting procedural standards, and overseeing internal teams and vendor operations to ensure compliance with key performance indicators (KPIs) and service level agreements (SLAs)
• The role is responsible for monitoring performance trends, collaborating with stakeholders, and coordinating with IT, vendors, and business teams to drive operational and technical enhancements
• With direction from the AVP of Claims, leads Payment Integrity process and staff management and initiative implementation, including: all pre- and post-pay claims processes, pre-pay editing for correct coding and medical payment policies, overpayment recovery and recoupment (overpayments, subrogation, COB, etc.) and premium enhancements (such as ESRD and Medicare Secondary Payer)
• Provides leadership to team members and responsible for assigning projects and activities involving inventory management, informational reporting, database configuration, procedures and workflows to ensure quality control and timely turnaround
• Responsible for facilitating meetings with company executives for presentation and approval of Payment Integrity initiatives
• Provides assessments and business rules to configuration for claims edit logic in the Epic Tapestry system as well as maintenance to the internal Payment Integrity tracking databases
• Works with AVP of Claims to identify automation opportunities to reduce G&A costs, and continue to drive positive operational and financial outcomes for all solutions and ensures CMS and state regulatory requirements are met.
• Supervise team activities, including inventory management, reporting, workflow development, and quality control; monitor performance, identify improvement opportunities, and implement corrective actions; present monthly operational reviews to leadership, including metrics, trends, and updates on process improvements.

The Skills, Experience & Education You Bring

• Bachelor's degree or equivalent combination of education and experience
• Vendor oversight and leadership reporting experience, including presenting metrics and trends to leadership
• Experience performing detailed root cause analysis of technical and/or operational processes and leading cross-functional project teams
• 10+ years of relevant experience in Payment Integrity or Payer Operations
• Preferred:
  • Experience with Epic Tapestry claims system
  • 7+ years in Payment Integrity specifically
  • Experience with BPO/BPaaS solutions
  • Experience with Medicare and Medicaid Managed Care programs

You Share Our Mission & Values:

• You are passionate about improving the healthcare experience and want to be part of the Altais mission.
• You are bold and curious- willing to take risks, try new things and be creative.
• You take pride in your work and are accountable for the quality of everything you do, holding yourself and others to a high standard.
• You are compassionate and are known as someone who demonstrates emotional intelligence, considers others when making decisions and always tries to do the right thing.
• You co-create, knowing that we can be better as a team than individuals. You work well with others, collaborating and valuing diversity of thought and perspective.
• You build trust with your colleagues and customers by demonstrating that you are someone who values honesty and transparency.

Altais values the contribution each Team Member brings to our organization. Final determination of a successful candidate’s starting pay will vary based on several factors, including, but not limited to education and experience within the job or the industry. The pay scale listed for this position is generally for candidates that meet the specified qualifications and requirements listed on this job description. Additional pay may be determined for those candidates that exceed these specified qualifications and requirements. We provide a competitive compensation package that recognizes your experience, credentials, and education alongside a robust benefits program to meet your needs.

The anticipated pay range for this role is listed in our salary posting for transparency but may vary based on factors including the candidate’s qualifications, skills, and experience.

Altais and its subsidiaries and affiliates are committed to protecting the privacy and security of the personal information you provide to us. Please refer to our ‘CPRA Privacy Notice for California Employees and Applicants’ to learn how we collect and process your personal information when you apply for a role with us.

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.