Director Payment Integrity - Healthcare Compliance Career in Columbus
Career & Market Insight
This is a senior director-level role with broad cross-functional responsibility — overseeing three critical compliance and operations functions simultaneously (QA, Grievances & Appeals, and FWA). It represents a significant leadership opportunity within a regional managed care organization.
Compensation context: No salary is listed, but Director of Payment Integrity roles in managed care typically range from $100,000–$140,000 annually in Midwest markets. Columbus, IN has a lower cost of living than major metro areas, so compensation may trend toward the lower end of national benchmarks. Candidates should negotiate accordingly.
Skills you'll develop or deepen:
- Regulatory mastery: CMS Part C, ODAG, state Department of Insurance compliance — highly transferable to larger health plans
- Multi-team people leadership and performance management
- Healthcare fraud investigation and FWA program design
- Data analysis and operational metrics reporting
Green flags: High visibility role reporting directly to a VP; breadth of responsibility accelerates career growth; regulatory expertise developed here is in strong demand across the industry.
Yellow flags: The role combines strategic director duties with direct daily supervision — meaning it may carry a heavy operational load. The requirement for experience with SIHO-specific systems (HSP claims) is narrow and suggests limited portability of that specific skill. Work-life balance signals are absent from the posting, and the "fast-paced, high-demand" language suggests a stressful environment.
Best suited for mid-career managed care professionals targeting a move into senior leadership within regional or specialty health plans.
Job Title: Director, Payment Integrity
Reports To: Vice President, Operations
This is an exempt position reporting to the Vice President, Operations. The Director of Payment Integrity is responsible for the Quality Assurance, Grievances & Appeals, and Fraud, Waste & Abuse teams. This role functions as both the director setting strategy for these departments and the direct supervisor managing day-to-day operations. This position interfaces with all departments of SIHO as well as external stakeholders, vendors, and customers. The ability to interact with all levels of SIHO staff and external parties with a high level of professionalism, while adapting quickly between multiple high-priority items, is essential.
Brief Description of Duties:
- Directly supervise and manage the Quality Assurance, Grievances & Appeals, and Fraud, Waste & Abuse teams, including day-to-day oversight, staffing, and performance management
- Read, research, and interpret federal and state regulations governing grievances and appeals, and translate regulatory requirements into practical, actionable process changes
- Continuously monitor and improve grievances and appeals processes to ensure ongoing compliance with CMS and state regulatory requirements
- Support the claims and benefit configuration quality assurance program, including developing and delivering training and education for staff
- Stay current on emerging fraud, waste, and abuse trends and lead efforts to proactively identify and investigate potential FWA
- Review results across all three departments and identify process improvement initiatives and cost savings opportunities
- Analyze department and operational data in Excel to identify trends and draw actionable insights
- Manage data transfers with vendor partners, meet with vendors regularly to ensure processes are working as intended, and escalate potential issues as they arise
- Interact directly with customers as needed
- Work with SIHO Legal and key leadership on special cases and external inquiries from CMS, the Indiana Department of Insurance, law enforcement, and others
- Develop, maintain, and report statistical measurements assessing the effectiveness of the QA, FWA, and G&A programs
- Lead or support key corporate and departmental compliance initiatives, including SOC audits, CMS Part C Reporting and ODAG, and others as assigned
Minimum Skills Requirement:
- B.S. degree or equivalent work experience in a healthcare operation
- 3–5 years experience in a managed care environment
- Strong understanding of federal and state regulations related to grievances and appeals, including CMS and state Department of Insurance requirements
- Experience across Medicare Advantage, ACA, employer group/TPA, and MEWA products preferred
- Demonstrated ability to lead and manage people and teams, while also directly supervising staff on a daily basis
- Proficient in Excel with the ability to analyze data and draw actionable insights
- Thorough understanding of medical and health plan terminology; familiarity with CPT, HCPCS, and ICD-10 coding a plus
- Excellent written and verbal communication skills, with the ability to clearly communicate with all levels of management as well as external entities, vendors, and customers
- Ability to work successfully at a self-directed pace in a changing, fast-paced, high-demand environment, adapting quickly between competing high-priority items
- Ability to work successfully under tight deadlines
- Experience with SIHO systems including the HSP claims system
- Proficient in Microsoft Office suite products including Word, Excel, PowerPoint, and Outlook
All positions are subject to change based on the needs of the business.
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Frequently Asked Questions
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