Director of Payment Integrity Operations

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🔴 Lead

⚙️ Operations

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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amps

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2005

🏥 Healthcare

💼 Consulting

🛡️ Insurance

Healthcare • Consulting • Insurance

AMPS is a leader in healthcare cost reduction for self-funded organizations, dedicated to transforming how businesses manage their healthcare spend. With nearly two decades of expertise, AMPS delivers innovative, member-centric solutions such as PriceDynamix, ClaimInsight, and Drexi that drive savings while maintaining high-quality care. Their personalized approach empowers organizations to take control of their healthcare costs without compromising member well-being, making them a trusted partner in achieving sustainable healthcare savings.

📋 Description

• Lead the strategic, operational, and analytical functions powering the ClaimInsight platform • Oversee identification, acquisition, processing, validation, and optimization of healthcare claims, payment integrity, and recovery opportunity data • Lead multidisciplinary teams of data analysts, data mining specialists, operations managers, and quality professionals • Establish scalable processes for data mining, opportunity identification, and inventory generation • Drive continuous improvement to increase claim opportunity yield, accuracy, recovery rates, and operational efficiency • Define growth objectives, operational KPIs, and client value metrics with executive leadership • Identify emerging market opportunities and analytic methodologies • Oversee claims and payment integrity data mining activities • Direct development and optimization of algorithms, business rules, and data models • Ensure high-quality inventories and prioritize opportunities based on recoverability, financial impact, and client objectives • Establish performance standards and quality assurance processes • Monitor inventory generation, throughput, aging, and financial yield • Develop operational dashboards and executive reporting • Implement workflow optimization initiatives to reduce cycle times and improve scalability • Partner with Product Management, Engineering, Data Science, Recovery Operations, and Client Success teams • Lead, mentor, and develop managers, analysts, and operational specialists • Build workforce planning models and create career development and succession planning strategies • Ensure adherence to HIPAA, PHI security requirements, data governance policies, contractual requirements, and regulatory compliance • Partner with compliance and legal teams on mining methodologies

🎯 Requirements

• Bachelor's degree in Data Analytics, Healthcare Administration, Business, Information Systems, Computer Science, Statistics, or related field • 10+ years of experience in healthcare claims analytics, payment integrity, recovery auditing, healthcare operations, or data mining • 5+ years of leadership experience managing analytics or operational teams • Strong knowledge of healthcare claims processing • Strong knowledge of medical coding systems (ICD, CPT, HCPCS) • Strong knowledge of Coordination of Benefits • Strong knowledge of Subrogation • Strong knowledge of payment integrity • Strong knowledge of retrospective recovery programs • Experience working with large healthcare claims datasets • Advanced proficiency with SQL and data analytics platforms • Demonstrated success leading operational transformation and process optimization initiatives • Preferred: Experience supporting health plans, TPAs, self-funded employers, or healthcare payment integrity organizations • Preferred: Familiarity with predictive analytics and machine learning applications • Preferred: Experience with cloud-based data environments, including Azure, AWS, or Google Cloud • Preferred: Lean Six Sigma certification or equivalent operational excellence training • Technical competencies: SQL, Power BI, Tableau, Azure Data Platform, Snowflake, Databricks, healthcare claims systems, data quality management, statistical analysis, predictive modeling, workflow automation, performance management analytics