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Avesis is a leading national dental and vision benefits administrator. The company serves Medicaid and Medicare Advantage plans, offering members comprehensive programs that focus on prevention and treatment. Avesis has developed innovative outreach and engagement services designed to ensure all members have access to care, no matter their socio-economic or health status. Avesis also serves the commercial marketplace as part of companies’ employee benefit programs. Partnered with a national network of dental and optical professionals, Avesis delivers high-value services that improve members’ health, allowing them to enjoy productive lives.

The Vice President, Payment Integrity leads Avesis’ enterprise-wide payment integrity strategy, with a focus on optimizing vendor performance through the gold carded vendor monitoring program. Blending financial acumen, clinical insight, and advanced analytics, the VP drives strategic initiatives that safeguard financial health, enhance operational efficiency, and mitigate fraud, waste, and abuse. The role oversees external vendor partnerships and internal cross-functional teams, delivering actionable intelligence through cost trend analysis, audit oversight, and contract optimization. Ideal for a visionary leader who thrives on data-driven strategy, innovation, and measurable impact.

Our chosen candidate will be responsible for designing and executing strategic programs that enhance financial performance and operational alignment across clinical and vendor operations. This includes leading the gold card program, overseeing vendor relationships, directing audit and compliance initiatives, and delivering executive-level reporting and insights. The VP will serve as a key advisor to senior leadership, translating complex data into strategic decisions that drive cost containment, quality improvement, and regulatory compliance.

Functional Competencies:

Vendor Monitoring & Audit Program Development

• Lead the strategic design and implementation of enterprise-wide monitoring programs for gold carded vendors, ensuring alignment with clinical, financial, and compliance objectives.
• Oversee monthly trend analyses and targeted audits to proactively identify performance deviations and risk areas.
• Partner with clinical leadership to prioritize audit focus areas using predictive analytics and data-driven insights.
• Provide executive oversight of documentation review and chart chase processes to ensure audit integrity and regulatory compliance.

Cost & Risk Analysis

• Direct high-level cost trending analyses for high-risk procedure codes across dental and vision services, identifying opportunities for cost containment and quality improvement.
• Translate complex financial data into strategic recommendations for clinical and operational leaders.
• Develop and deploy targeted audit strategies informed by utilization patterns, financial impact, and risk exposure.
• Lead post-audit strategic planning, including provider education, financial recoupment, and fraud/waste/abuse escalation protocols.

Cross-Functional Coordination

• Serve as the executive liaison to internal stakeholders, driving collaboration and execution of audit-related initiatives.
• Foster a culture of transparency, continuous improvement, and shared ownership of payment integrity outcomes.
• Facilitate monthly cross-departmental meetings to ensure alignment and execution of audit-related actions.

Vendor Oversight & Payment Integrity

• Provide strategic oversight of external vendors supporting payment integrity, ensuring performance metrics, contractual obligations, and audit recommendations are met.
• Evaluate vendor-generated insights and coordinate operational deployment of post-audit recoupment strategies.
• Maintain a forward-looking roadmap for audit edits (pre- and post-payment), including stakeholder engagement and change management planning.

Reporting & Performance Tracking

• Oversee the development of executive dashboards and reporting frameworks to monitor initiative progress, financial impact, and vendor performance.
• Deliver high-impact insights and strategic updates to senior leadership, enabling data-informed decision-making and resource allocation.

Provider Agreement Analysis

• Lead financial eval