Director Quality – Payment Integrity

🕒 Maio 4

🇺🇸 Estados Unidos – Remoto (EUA)

💵 $140.000 - $185.000 / ano

⏰ Tempo Integral

🔴 Especialista

👔 Diretor

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Cotiviti

SiteLinkedInTodas as Vagas

5001 - 10000 funcionários

⚕️ Seguro de Saúde

💳 Fintech

🤖 Inteligência Artificial

Healthcare Insurance • Fintech • Artificial Intelligence

Cotiviti é uma empresa de tecnologia e análise em saúde que se especializa em melhorar a precisão e o desempenho dos pagamentos por meio de soluções avançadas de análise de dados. Eles se associam a planos de saúde, agências governamentais e provedores de serviços de saúde para fornecer insights que aprimoram a qualidade e a eficiência na prestação de cuidados. Com soluções como ajuste de risco, gerenciamento de políticas de pagamento e engajamento de membros, a Cotiviti busca otimizar os resultados financeiros e clínicos para o ecossistema de saúde.

Descrição

• Oversee and drive quality performance across payment integrity solutions, ensuring continuous improvement and operational excellence • Collaborate with cross-functional business units to measure, report, and enhance quality performance metrics and outcomes • Develop and align best-in-class quality processes and standards, delivering exceptional results through operational excellence • Work closely with Operations and Product teams to drive quality improvements by leveraging technology, optimizing processes, and developing talent • Ensure timely and accurate responses for Payment Requests for Information (RFIs) and Request for Proposals (RFPs) • Support client intake requests for PrePayment Business Unit by understanding client requirements and providing tailored solutions and cost estimates • Hire, develop, coach, and retain top-tier talent, fostering a culture dedicated to exceptional quality and customer satisfaction • Optimize labor and operating expenses while increasing productivity, service quality, and supporting future client growth • Lead and support operational improvement initiatives encompassing people, processes, and technology to deliver incremental value and operational efficiency, consistently meeting or exceeding service and quality goals • Enforce Cotiviti’s intellectual property protection best practices throughout all operations • Diagnose and resolve issues proactively, manage schedules, and ensure deadlines are met for timely completion of work • Develop short-term and long-term plans to anticipate client needs and operational improvements • Cultivate a positive workplace culture that supports corporate goals, promotes initiative, and fosters open communication at all organizational levels • Collaborate and support business leaders throughout the organization, maintaining highly effective client and team dynamics in a collaborative environment • Manage and delegate team and individual projects/assignments, and review performance against operating plans and standards • Provide comprehensive reports and metrics to drive operational quality and inform strategic decisions, based on operational objectives and work plans at a senior level • Build, maintain and influence strong relationships with executive leadership to support organizational goals

🎯 Requisitos

• Bachelor’s degree in business, operations, healthcare or equivalent in a related field required and Master’s preferred • Minimum of five years’ management experience, ideally within the healthcare industry • Demonstrated operational excellence, exceptional problem-solving ability, and proven people leadership skills • Expertise in collaborating with key stakeholders and executive decision-makers • Established leadership in directing operational divisions, shaping policies, practices, and achieving division objectives • Highly developed interpersonal, analytical, and communication skills • Proven track record of driving business improvement initiatives and delivering measurable outcomes • Deep process-oriented expertise, with a focus on simplifying and scaling operations while maintaining superior quality • Advanced technological proficiency, including experience in software development and payment integrity solutions • Significant experience presenting to clients and senior leadership • Exceptional performance management skills demonstrated through outstanding team and organizational outcomes • Ability to excel within fast-paced, highly accountable, and diverse environments, maintaining a strong client and customer service focus • Extensive experience in strategic planning and operational development • Superior analytical and problem-solving capabilities, with a talent for diagnosing and resolving operational inefficiencies • Experience operating in matrixed organizational structures • Willingness to travel as business needs require • Strong foundation in quality assurance and testing methodologies • Experience designing and implementing quality measurement frameworks • Demonstrated capability to align and standardize quality processes across a portfolio of products • Expertise in establishing and maintaining mechanisms for performance monitoring and reporting to senior leadership

🏖️ Benefícios

• medical, dental, vision, disability, and life insurance coverage • 401(k) savings plans • paid family leave • 9 paid holidays per year • 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti