Senior Director, Payment Integrity Operations

🕒 May 8

🇺🇸 United States – Remote

💵 $160k - $190k / year

⏰ Full Time

🟠 Senior

⚙️ Operations

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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

• 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

🎯 Requirements

• 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

🏖️ 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