A Lifelong Advocate for Health Plans: A Conversation with Kimberly Fadden, SVP of Client Management

Payment Integrity Innovation: Q&A with Kimberly Fadden

Amanda Bair: You’ve spent your entire career in healthcare. What first drew you to the industry, and what keeps you passionate after 40 years?

Kimberly Fadden: Honestly, I fell into it. I was still in high school when my dad asked a neighbor—who happened to be the head of Intermountain Healthcare—if they had any summer jobs. They hired me as a receptionist, and one of my first tasks was typing SMFs. I had no idea what that meant at the time!

I ended up rotating across the organization and fell in love with the work. I did leave the industry briefly, when I moved from Motorola’s electronic medical records (EMR) division to their government business sector. But after only two weeks, I realized my heart was in healthcare, not just technology. What keeps me passionate is that healthcare is always changing, and you can truly make a difference. I especially love working with clients, understanding their challenges and helping them solve problems that improve outcomes.

AB: You’ve held leadership roles across providers, payers, and vendors. How has that breadth shaped your approach?

KF: I had a mentor—an oncologist who was also an attorney—who told me, “Don’t sit in the same chair for too long, or you’ll just repeat your learnings.” That advice stuck.

I sought out roles in operations, product, implementations, client management, sales, risk adjustment, claims editing, behavioral health—you name it. That breadth means when I sit across from a health plan executive today, I understand their pressures. I’ve been in their shoes. That perspective builds trust quickly.

AB: Looking back, what industry changes stand out the most?

KF: Star Ratings were a game-changer. They brought quality to the forefront.

I’ve also seen the pendulum swing over and over: outsourcing to vendors and then bringing work back in-house, tightening and loosening prior authorizations. I joke that we boomerang as an industry.

EMRs are another surprise. We were talking about data sharing 40 years ago, and yet we still haven’t achieved the interoperability other industries—like banking—did decades ago.

And payment integrity has shifted dramatically. We’ve seen a strong move toward prepay strategies, which I think is one of the biggest pivots in recent years. Now, with today’s cost pressures and medical loss ratio (MLR) requirements, health plans are rethinking their approaches yet again.

I’m also curious to see how AI plays out. Not to replace people, but to help reduce administrative burdens if applied smartly.

AB: What are the biggest challenges payment integrity leaders face today?

KF: MLR is front and center. It influences everything: from staffing levels to technology investments to how payment integrity leaders structure vendor relationships.

Another shift is the move away from contingency-based vendor arrangements to set license fees. Plans want predictable costs, and that changes the dynamics of how vendors deliver value.

AB: How do you approach partnering with health plans to help them succeed in that environment?

KF: I live by the four T’s: teamwork, trust, truth, and transparency.

This industry is both large and small; your reputation follows you. Clients need to know you’ll be honest with them, even when the answer isn’t what they want to hear. I also believe in earning the right to expand a relationship. First, deliver on what they’ve already entrusted to you. Only then do you talk about the next thing.

My focus is always on finding the win-win solution that helps the client succeed and strengthens the partnership. That’s where the magic happens.

AB: Can you share an example of that consultative approach in action?

KF: One health plan was building a large data hub. In conversations with them, we realized a different approach focused on editing would better meet their needs.

Another time, a plan evaluating new claims editing vendors asked for my advice simply because I had so much experience in that space. I wasn’t trying to sell them anything; I was helping them think it through. That kind of genuine help builds trust and often leads to stronger partnerships down the road.

AB: What advice would you give to payment integrity leaders navigating today’s challenges?

KF: Build a trusted network. Surround yourself with peers, mentors, and experts you can bounce ideas off and learn from. No one person or organization has all the answers, but collectively we have incredible insight to share.

AB: With such a demanding career, how do you recharge outside of work?

KF: Family has always come first for me. I love the outdoors – skiing and football games – cooking, traveling and just spending time with my two sons. I’ll never forget flying home in the middle of negotiating an $800 million contract just so I could be at one of their basketball games.

Work comes and goes, but family is forever. That perspective keeps me grounded.

Conclusion

Kimberly’s career reflects both the arc of healthcare technology and the power of client-centered leadership. Her commitment to transparency, practical solutions, and building genuine partnerships has earned her the trust of health plans nationwide.

As payment integrity evolves—driven by MLR pressures, new technologies, and ongoing industry shifts—leaders like Kimberly show that lasting impact starts with experience, empathy, and doing the right thing for clients.