Senior Director, Payment Integrity Operations

Vaga não está no LinkedIn

🕒 Maio 8

🇺🇸 Estados Unidos – Remoto (EUA)

💵 $160.000 - $190.000 / ano

⏰ Tempo Integral

🟠 Sênior

⚙️ Operações

🦅 Patrocina Visto H1B

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Cotiviti

SiteLinkedInTodas as Vagas

5001 - 10000 funcionários

🏥 Saúde

💼 Consultoria

📦 Logística

Healthcare • Consulting • Logistics

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

• Represent the business unit and operations by defining operational requirements that enable scalable, efficient, and high-quality delivery • Respond promptly to Payment Requests for Information and Requests for Proposals • Support client intake requests for the PrePayment business unit by understanding client requirements and providing tailored solutions and cost estimates • Hire, develop, coach, lead, and retain top-tier talent, fostering a team and culture dedicated to implementing best-in-class practices that drive superior internal and external customer satisfaction • Optimize labor and operating expenses while increasing productivity, service quality, and supporting future client growth • Collaborate with key partners to ensure operational excellence • Sponsor, lead and support operational improvement initiatives related to people, processes, and technology to deliver incremental value, enhance operational efficiency, and meet or exceed service and quality goals • Develop lean business cases, establish key performance indicators, and create requirements and test plans for business improvement initiatives • Communicate business unit performance and improvement initiatives to relevant stakeholders • Enforce Cotiviti’s intellectual property protection best practices • Ensure clinical operations comply with regulatory, accreditation, corporate, and client requirements • Diagnose and resolve issues, prepare schedules, and set deadlines to ensure timely completion of work • Develop short-term and long-term plans to anticipate client needs and drive operational improvements • Foster a positive culture that supports corporate goals, encourages initiative, and promotes open communication across all levels of the organization • Work closely with and support business leaders throughout the organization • Establish and maintain effective client and team dynamics in a highly collaborative manner • Manage and delegate team and individual projects and assignments • Review performance against operating plans and standards • Provide reports and metrics to drive continuous operational quality • Cultivate and maintain personal relationships with executive leadership • Complete all responsibilities as outlined in the annual Performance Plan • Complete all special projects and other duties as assigned

🎯 Requisitos

• Bachelor’s degree in business, operations, healthcare or equivalent in a related field required and Master’s preferred • Relevant certifications such as Lean Six Sigma, PMP, or Certified Payments Professional (CPP) are highly regarded • A minimum of 10 years’ experience managing operations, consulting, or healthcare management, including decision rights for hiring and terminating employees, and management of operational budgets • Experience in US healthcare health plan operations (pre-adjudication, post adjudication or adjudication) preferred • Implementations/transitions experience preferred • Exceptional operational acumen, advanced problem-solving capabilities, and proven leadership skills • Demonstrated experience collaborating with key stakeholders and executive decision-makers • Robust leadership background in directing operational divisions, establishing policies, and driving achievement of division objectives • Highly developed interpersonal, analytical, and communication abilities • Proven record of delivering significant business improvements and operational excellence • Deep expertise in process optimization, enabling simplification and scalable quality solutions • Comprehensive understanding of technology, including experience with software development initiatives • Extensive experience presenting to clients and senior leadership teams • Skilled in responding to client information requests, audits, and proposal submissions • Ability to thrive in a fast-paced, high-accountability, and diverse environment, with relentless focus on client and customer service • Distinguished leadership qualities and a successful track record in talent management and development • Strong analytical and problem-solving acumen, with the ability to deeply assess and resolve operational inefficiencies • Superior written and verbal communication skills, including expertise in public speaking • Advanced proficiency in Microsoft Office Suite, including Word, Excel, and PowerPoint • Professional demeanor with the ability to maintain confidentiality • Capable of working independently and collaboratively within team settings; adept at multitasking, prioritizing, and meeting deadlines • Experience operating effectively in a matrixed organizational structure • Willingness and ability to travel as required • Demonstrates flexibility and willingness to actively participate in the operations of an international organization, including attending conference calls scheduled to accommodate global time zones • Experience in collaborating with sales teams and driving initiatives that support business growth • Consistent track record of achieving and surpassing service level agreements (SLAs) and performance benchmarks • Strategic capability to position the organization for sustained growth in alignment with the Payment business unit’s objectives

🏖️ 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