AVP, Payor Collaboration and Interoperability

Vice President, Payor Collaboration And Interoperability

Ensemble Health Partners is seeking a seasoned Vice President, Payor Collaboration and Interoperability to lead a new strategic function focused on transforming payer-provider collaboration. This executive will be responsible for forging partnerships that reduce administrative waste, improve interoperability, and ensure patients receive the right care in the right setting at the highest quality.

The ideal candidate will bring extensive experience within major health insurance organizations, with a strong understanding of payer operations, data systems, reimbursement policy, and cross-functional collaboration across claims, utilization management, and network operations. This leader will apply that payer expertise to build durable, mutually beneficial partnerships between Ensemble and its payer counterparts.

Develop and lead Ensemble’s payer collaboration strategy focused on administrative simplification, data transparency, and friction reduction.

Design frameworks for long-term payer-provider collaboration, emphasizing shared savings, operational efficiency, and aligned incentives.

Drive interoperability initiatives that enable real-time data exchange and automation across pre-authorization, eligibility, and claims processing using FHIR, TEFCA, and X12 standards.

Ensure Ensemble’s approach aligns with CMS and NCQA interoperability requirements, as well as broader national initiatives such as CAQH CORE.

Build joint operating models with payer partners, including governance structures, accountability mechanisms, and performance metrics.

Work with technology and data teams to integrate payer data into Ensemble’s workflow and analytics platforms to drive denial prevention, payment accuracy, and quality improvement.

Leverage payer insights to develop predictive and preventive solutions that improve patient access and care coordination.

Serve as the executive sponsor for payer-driven innovation pilots and joint process redesign initiatives.

Act as the primary relationship owner for senior payer executives, fostering trust-based collaboration and problem-solving.

Represent Ensemble in national payer and policy forums on interoperability and administrative simplification.

Partner with provider clients and Ensemble’s operations and technology teams to align payer strategies with revenue cycle optimization goals.

Translate successful collaborations into scalable, technology-enabled models for broader client adoption.

15+ years of leadership experience in major health insurance or managed care organizations (e.g., national or regional payers, PBMs, or utilization management firms).

Deep expertise in payer operations, claims administration, utilization management, reimbursement policy, and interoperability standards (FHIR, HL7, X12, APIs).

Demonstrated success leading payer-provider partnerships or joint innovation initiatives that achieved measurable administrative and cost efficiency gains.

Strong understanding of CMS regulations, value-based care models, and network performance improvement.

Proven ability to navigate complex stakeholder environments and align payer and provider incentives.

Bachelor’s degree required;
Master’s degree in Health Administration, Business, or Public Policy preferred.

Payer Strategist: Brings firsthand understanding of payer systems, incentives, and operational levers.

Bridge Builder: Able to translate payer priorities into shared outcomes for providers and patients.

Innovator: Applies modern technology and data interoperability to streamline administrative processes.

Outcome-Driven Operator:
Moves quickly from strategic design to measurable impact.

Five-time winner of "Best in KLAS" ,

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