Director - Payment Integrity Transformation

Role Description

This role is to build and implement an effective implementation process and framework for PI audit programs (Datamining and Clinical) and the major functions in the end to end cycle leveraging an integrated PI technology platform to understand the tasks involved related to client implementations.

One of our key goals of this role is to offer our clients an excellent onboarding experience in a timely manner for quick realization of savings.

Qualifications

A Bachelor's Degree / MBA

8+ years of relevant experience in Payment Integrity

10+ years’ experience in end to end new client implementations on data mining/clinical/coding programs

Requirements

Effective handling of highly sensitive, and often highly confidential, information using exemplary judgment, tact and diplomacy

Exposure to budget, forecast and resource management

Knowledge of Project management methodologies such as Agile, Waterfall

Good written/verbal communication including effective interpersonal skills

Proven interpersonal skills while contributing to team effort by accomplishing related results as needed

Must be a team player and adaptable to a dynamic work environment

Key Responsibilities

Set up and lead high performing teams with cross-functional experience in implementation of end to end Payment Integrity programs in both Pre Pay and Post Pay, including Data Mining, DRG, Home Health, SNF, HCD/DME audit types

Monitor onboarding and offboarding of resources activity including access management

Support Artifact / Deliverable Management processes, including:

Monitoring and reporting timely submission of client deliverables

Collation and initial quality review of deliverables for submission

Maintain process documents and template updates

Maintain and configure Project Management tools

Maintain resource trackers and other forecast information of the project

Assist project teams with the timely identification, management and resolution of action items, risks, and issues

Prepare executive status reports with a high level of accuracy

Independently prepare project and program communications

Participate and prepare materials for meetings

Monitor Quality Assurance Activities like adherence to compliance items and escalate risks/issues to team leader

Review time reports and follow up with any resources to ensure that any missing time is captured and recorded correctly

Work plan management across multiple projects

Work on ad-hoc tasks as directed by leadership, in a timely manner with a high level of accuracy

Location

Work@Home USA, United States of America