Senior Director, Payment Integrity Operations

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

📋 Description

• Act as the representative for the business unit and operations by outlining operational requirements that facilitate scalable, efficient, and high-quality delivery.

• Respond swiftly to Payment Requests for Information and Requests for Proposals.

• Assist in client intake requests for the PrePayment business unit by comprehending client needs and offering customized solutions and cost estimates.

• Recruit, develop, mentor, lead, and retain high-caliber talent, nurturing a team culture dedicated to implementing industry-leading practices that enhance internal and external customer satisfaction.

• Streamline labor and operating costs while boosting productivity, service quality, and supporting future client expansion.

• Collaborate with key stakeholders to ensure operational excellence.

• Sponsor, lead, and support initiatives aimed at operational improvement concerning personnel, processes, and technology to deliver incremental value, enhance operational efficiency, and meet or exceed service and quality objectives.

• Create lean business cases, define key performance indicators, and develop requirements and test plans for business improvement projects.

• Communicate the performance of the business unit and improvement projects to relevant stakeholders.

• Uphold Cotiviti’s best practices for intellectual property protection.

• Ensure that clinical operations adhere to regulatory, accreditation, corporate, and client requirements.

• Diagnose and resolve issues, develop schedules, and establish deadlines to guarantee timely completion of tasks.

• Formulate short-term and long-term strategies to anticipate client requirements and drive operational enhancements.

• Promote a positive culture that aligns with corporate objectives, fosters initiative, and encourages open communication across all organizational levels.

• Work closely with and provide support to business leaders throughout the organization.

• Establish and maintain effective client and team dynamics in a highly collaborative environment.

• Manage and assign team and individual projects and responsibilities.

• Evaluate performance against operational plans and standards.

• Provide reports and metrics to facilitate continuous operational quality improvement.

• Build and maintain personal relationships with executive leadership.

• Complete all duties as outlined in the annual Performance Plan.

• Undertake all special projects and additional tasks as assigned.

⛳️ Requirements

• A Bachelor’s degree in business, operations, healthcare, or a related field is required; a Master’s degree is preferred.

• Relevant certifications such as Lean Six Sigma, PMP, or Certified Payments Professional (CPP) are highly valued.

• At least 10 years of experience managing operations, consulting, or healthcare management, including authority over hiring and termination decisions as well as managing operational budgets.

• Experience in US healthcare health plan operations (pre-adjudication, post-adjudication, or adjudication) is preferred.

• Experience with implementations/transitions is preferred.

• Outstanding operational insight, advanced problem-solving skills, and proven leadership capabilities.

• Demonstrated experience working collaboratively with key stakeholders and executive decision-makers.

• Strong leadership background in overseeing operational divisions, formulating policies, and driving the achievement of division objectives.

• Highly developed interpersonal, analytical, and communication skills.

• Proven track record of delivering significant business enhancements and operational excellence.

• Extensive expertise in process optimization, enabling simplification and scalable quality solutions.

• Comprehensive understanding of technology, including involvement in software development projects.

• Significant experience presenting to clients and senior leadership teams.

• Proficient in responding to client information requests, audits, and proposal submissions.

• Ability to thrive in a high-paced, high-accountability, and diverse environment with a relentless focus on client and customer service.

• Distinguished leadership attributes and a successful history in talent management and development.

• Strong analytical and problem-solving skills, with the capability to thoroughly assess and address operational inefficiencies.

• Exceptional 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 both independently and collaboratively within team settings; adept at multitasking, prioritizing, and meeting deadlines.

• Experience functioning effectively in a matrixed organizational framework.

• Willingness and capability to travel as needed.

• Demonstrates flexibility and readiness to actively engage in the operations of an international organization, including attending conference calls scheduled to accommodate global time zones.

• Experience collaborating with sales teams and driving initiatives that bolster business growth.

• Consistent history of meeting and exceeding service level agreements (SLAs) and performance metrics.

• Strategic capability to position the organization for sustained growth in alignment with the objectives of the Payment business unit.

🏝️ 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.