Vice President, Payment Integrity

🕒 Setembro 25

🧀 Wisconsin – Remoto

🧀 Wisconsin – Remote

💵 $156.100 - $223.000 / ano

⏰ Tempo Integral

🔴 Especialista

👔 Vice-presidente

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Gainwell Technologies

SiteLinkedInTodas as Vagas

10.000+ funcionários

💼 Consultoria

📦 Logística

⚕️ Seguro de Saúde

💰 Grant em 2023-06

Consulting • Logistics • Healthcare Insurance

A Gainwell Technologies é a principal provedora do país de soluções digitais e cloud-enabled em todo o ecossistema de serviços humanos e saúde pública. Com uma abordagem orientada por propósito, a Gainwell atende clientes nos 50 estados dos EUA, com foco em melhorar os desfechos em saúde e oferecer experiências intuitivas e centradas nas pessoas. Seu portfólio abrangente inclui modernização do Medicaid Enterprise, data analytics, serviços para prestadores e soluções para farmácia — tudo projetado para impulsionar o futuro da saúde e promover o bem-estar das comunidades.

Descrição

• Develop high-quality business strategies and operational plans aligned with Gainwell’s short-term and long-term objectives for the solution offering • Oversee payment integrity delivery operations to drive revenue growth, margin expansion, and client satisfaction • Lead and motivate team members, develop a high-performing managerial team, and partner cross-functionally with Finance, Account Management, Sales, Engineering, and Implementations • Manage pre-payment and post-payment payment integrity solutions, including Clinical Claim Reviews, Payment Analytics/Data Mining, FraudCapture, Utilization Review, Long-Term Care, and Credit Balance • Develop, manage, and attain revenue and expense budget goals • Manage product portfolio development plans with technical development partners in alignment with client needs and revenue forecasting • Monitor systems and processes that identify and mitigate payment integrity revenue portfolio opportunities and risks • Apply advanced financial analysis and forecasting techniques to project and optimize revenue • Collaborate with the VP Product on product expansion and annual revenue targets • Partner with the AI development team on projects improving efficiency, accelerating growth, and speeding go-to-market solutions • Represent the company in pre-sales solutioning efforts and collaboratively design solutions with Gainwell SGMs and HMS SVP Client Management • Partner with clinical operations on demand, capacity, and compliance with client SLAs and contract requirements • Oversee RFP and new business proposal reviews for strategic fit and implementation, operational, and financial success • Improve product quality through defect identification, root cause analysis, and corrective action project management • Improve internal product processes through Lean and AI-driven continuous quality improvement methodologies • Manage staffing planning and workforce management tools across the delivery team • Build operational metrics covering service efficiency, quality, cost per unit, productivity, staffing to demand, appeals, and analytics efficacy • Coordinate with the product implementation team on solution architecture and end-to-end project management of new implementations • Communicate product strategy, financial results, operational status, and quality/compliance issues to company leadership • Lead delivery teams through regular communication, recognition, and quarterly Town Hall meetings • Direct leadership development and training, including bench strength and succession planning • Participate in talent and succession management review sessions as a Talent Management champion

🎯 Requisitos

• At least fifteen years of gradually increasing product, finance and/or operational leadership experience • Experience working within the payer side of the healthcare industry required • Experience with Medicaid preferred • At least five years of leadership experience in payment integrity operations required • Familiarity with AI interventions leading to revenue acceleration and cost reduction strongly preferred • Strong interpersonal and influence skills to cultivate relationships, facilitate negotiations, and build partnerships with customers and key stakeholders • Strong strategic management, product management, planning, operational and analytical skills • Proven experience working in complex organizations • Travel based on client, program, and leadership needs, anticipated up to 15% annually

🏖️ Benefícios

• Work flexibility • Learning and career development • Technical credentials and certifications • Generous, flexible vacation policy • Educational assistance • Comprehensive leadership and technical development academies • 401(k) employer match • Comprehensive health benefits • Travel expense reimbursement (included among Gainwell’s stated benefits) • Life insurance (included among Gainwell’s stated benefits)