Director Quality – Payment Integrity

🕒 May 4

🇺🇸 United States – Remote

💵 $140k - $185k / year

⏰ Full Time

🔴 Lead

👔 Director

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Cotiviti

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

⚕️ Healthcare Insurance

💳 Fintech

🤖 Artificial Intelligence

Healthcare Insurance • Fintech • Artificial Intelligence

Cotiviti is a healthcare technology and analytics company that specializes in improving payment accuracy and performance through advanced data analytics solutions. They partner with health plans, government agencies, and healthcare providers to deliver insights that enhance quality and efficiency in care delivery. With solutions such as risk adjustment, payment policy management, and member engagement, Cotiviti aims to optimize financial and clinical outcomes for the healthcare ecosystem.

📋 Description

• 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

🎯 Requirements

• 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

🏖️ Benefits

• 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