Project Manager – Payment Integrity, Quality Operations

This is a fully remote position, open to applicants in United States.

📋 Description

• Collaborate with quality leaders, quality audit teams, reporting, MIS, configuration, technology teams, offshore quality partners, and end users to identify quality system requirements, workflow necessities, priorities, and opportunities for enhancements.

• Manage assigned roadmap initiatives from inception to completion, encompassing workflow modifications, process enhancements, reporting necessities, business workflow testing, new client workflow establishment, implementation schedules, stakeholder follow-ups, barrier resolution, and project closure.

• Construct and uphold test plans, test scenarios, test scripts, issue logs, implementation trackers, and testing documentation.

• Conduct user acceptance testing, regression testing, end-to-end validation, business workflow testing, and data validation prior to deployment.

• Record testing outcomes, defects, risks, decisions, approvals, open items, testing evidence, and implementation results.

• Drive defect follow-up by diagnosing issues, validating fixes, confirming quality standards, and providing status updates.

• Oversee the intake, review, prioritization support, and tracking of enhancement requests.

• Confirm configuration updates, user interface modifications, and workflow enablement activities.

• Develop rollout strategies including timelines, stakeholder communications, training requirements, go-live readiness, and post-launch support.

• Create and maintain user manuals, job aids, release notes, FAQs, training materials, process flows, and support resources.

• Facilitate training sessions, demonstrations, knowledge transfer activities, and stakeholder walkthroughs.

• Monitor system performance, workflow outcomes, user feedback, reporting outputs, and post-launch challenges.

• Assess workflows, system capabilities, business rules, reporting outputs, quality processes, and user experience to suggest enhancements.

• Ensure compliance with operational standards, audit requirements, HIPAA regulations, business process controls, and governance procedures.

• Act as the primary contact for inquiries regarding the quality system, issue escalation, defect follow-up, stakeholder coordination, and support.

⛳️ Requirements

• Bachelor’s degree in healthcare administration, business, quality management, project management, analytics, information systems, or a related field is preferred.

• Lean Six Sigma, PMP, CAPM, or similar process improvement/project management certifications are preferred.

• 5–7 years of experience, or an equivalent background, in project coordination, healthcare operations, claims auditing, quality operations, Payment Integrity, system testing, reporting, data analysis, or process enhancement.

• Experience in supporting system enhancements, workflow modifications, user interface updates, business workflow testing, user acceptance testing, regression testing, test scenario development, and end-to-end validation.

• Familiarity with healthcare claims auditing, Payment Integrity workflows, quality audit operations, healthcare audit terminology, compliance requirements, HIPAA, audit expectations, and business process controls.

• Practical experience in documenting requirements, test plans, test scripts, testing results, defects, risks, approvals, rollout plans, implementation outcomes, and issue resolution.

• Project management or strong project coordination experience is essential, including handling timelines, milestones, risks, roadblocks, stakeholder updates, enhancement tracking, implementation support, post-launch follow-up, and project closure.

• Proficient Excel and presentation skills are required.

• Strong understanding of healthcare audit operations, quality workflows, quality business processes, reporting requirements, and operational support needs within Payment Integrity.

• Exceptional analytical, problem-solving, organization, prioritization, documentation, follow-up, and stakeholder management abilities.

• Capacity to comprehend workflow logic, business rules, audit process steps, reporting outputs, testing outcomes, and operational impacts.

• Skill in translating quality priorities into explicit project plans, workflow solutions, quality controls, and sustainable operating practices.

• Ability to convey information clearly through written updates, verbal discussions, presentations, testing summaries, risk updates, action items, and recommendations.

• Capability to collaborate with onshore quality teams, offshore quality partners, configuration, MIS, reporting, training, technology partners, and end users.

• Proficiency to independently manage assigned tasks, conduct testing and validation activities, drive workflow enhancements, strengthen quality controls, and deliver work promptly.

🏝️ Benefits

• Up to 10% annual travel for team meetings and limited client onsite engagements.

• Benefits information is accessible at https://www.exlservice.com/us-careers-and-benefits.

• 100% remote work from a home office.