Director Payment Integrity

For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.

**Role Overview**

The **Director of Payment Integrity Solutions** is responsible for overseeing Payment Integrity edit and program strategy and performance across all ACFC lines of business and products (Medicaid, Medicare, Exchange, PBM, BH). This role ensures that implemented solutions deliver measurable value through rigorous analytics, including the use of artificial intelligence (AI), machine learning (ML), and NLP-based automation, coupled with continuous policy refinement, and strong Plan and provider stakeholder engagement. The Director leads efforts to monitor effectiveness, address operational...