VP, Clinical Innovation

About the Role:

We are seeking an experienced and visionary Vice President of Clinical Innovation to lead the transformation of complex payment solutions through the strategic use of artificial intelligence (AI), cutting-edge technologies, and a deep understanding of clinical billing and payment. This senior leadership role will be responsible for pioneering new approaches to clinical payment data analysis, enhancing the accuracy, efficiency, and overall quality of complex payment reviews within our organization. The VP will collaborate with cross-functional teams to integrate solutions into payment workflows, ensuring better decision-making and improved financial outcomes. This position will also play a key role in new content development, building strong, long-term relationships with customers, and applying clinical and coding knowledge to enhance payment review processes.

Key Responsibilities:

• Strategic Leadership: Lead the development and execution of the clinical innovation strategy, focusing on leveraging advanced technologies to transform complex payment review processes. Align initiatives with organizational goals to drive meaningful change in healthcare payment operations.
• AI and Technology Integration: Identify and implement AI-driven solutions to enhance the accuracy and efficiency of complex payment reviews, ensuring compliance with healthcare financial standards and regulations. Partner with technology teams to develop and deploy cutting-edge models that improve payment workflows.
• Innovation and Research: Stay ahead of industry trends, emerging technologies, and regulatory changes in healthcare. Foster a culture of innovation by continuously exploring new processes and technologies that can positively impact payment review processes and financial operations.
• New Content Development: Lead efforts in developing new content, resources, and tools to support and improve complex payment review processes. Ensure that content aligns with the latest regulatory changes, industry best practices, and clinical coding standards.
• Building Customer Relationships: Build and nurture strong relationships with customers, including healthcare providers, payers, and other stakeholders. Work closely with clients to understand their needs and challenges, ensuring the delivery of high-value solutions that enhance their payment review processes and improve financial outcomes.
• Clinical and Coding Knowledge: Leverage a deep understanding of clinical practices and coding systems (e.g., ICD-10, CPT, HCPCS) to enhance the accuracy and efficiency of complex payment reviews. Ensure that payment review processes align with current clinical standards and coding regulations to prevent errors and ensure compliance.
• Data-driven Decision Making: Utilize data analytics to monitor and measure the effectiveness of solutions, ensuring continuous improvement. Develop metrics and KPIs to assess the success of clinical innovation initiatives.
• Quality and Compliance: Ensure that innovations in complex payment reviews adhere to all regulatory, ethical, and financial quality standards. Work with legal, compliance, and risk management teams to mitigate any potential risks associated with new technologies.
• External Partnerships and Thought Leadership: Represent the organization in external forums, industry conferences, and thought leadership opportunities. Develop and maintain relationships with key partners, vendors, and academic institutions to advance complex payment review innovation initiatives.

Qualifications:

• Proven experience (10+ years) in clinical leadership roles, with at least 5 years in senior payment integrity positions.
• Expertise in the application of AI, machine learning, and automation technologies within healthcare financial operations, particularly in complex payment review processes.
• Deep understanding of payment review workflows, healthcare payment systems, clinical practices, and coding systems (e.g., ICD-10, CPT, HCPCS).
• Strong track record of leading successful innovation projects, especially those that integrate AI and technology into payment review processes.
• Experience in developing new content and resources to support business objectives and drive client success.
• Proven ability to build and maintain strong customer relationships, with a focus on understanding client needs and delivering impactful solutions.
• Ability to think strategically and lead cross-functional teams in a complex, fast-paced environment.
• Excellent communication and interpersonal skills, with the ability to engage and influence stakeholders at all levels of the organization.
• Nursing degree or advanced clinical degree is highly preferred.