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A bit about us:
Were on a mission to change healthcare how its paid for, delivered, experienced. We want to put people center stage, not process or profit. We are guided by a deep belief that every person on Medicare should be treated like we would treat a member of our own family: with loving care and a profound commitment to their health and well-being.
Thats why were gathering a whole bunch of smart, big-hearted people to create a new kind of healthcare company one that combines compassion, health insurance, clinical care, and technology seamlessly.
We want to throw the long ball with people we love for a cause we believe in. Life is short. Join us.
As the Payment Integrity Leader, you will be building a program from the ground up. Accountable for building a program that ensures claims are processed accurately according to industry standard norms to ensure Devoted Health is not overpaying/underpaying network providers. The leader will align strategic goals and objectives with decisions regarding post-pay and pre-pay audit functions, provider-facing functions and overall analytics. Identifies and implements technologies, workflows and partnerships to effectively meet strategic commitments. Immediate goals will be to stand up vendors and or internal programs to support our efforts across the payment integrity functions list below, which are not all-inclusive:
DRG & Medical Bill Audit
Provider Contracting accuracy
Data Mining (Claim edits)
Fraud, Waste and Abuse
Responsibilities will include:
- Provides leadership for overall Payment Integrity strategy for Operations.
- Oversees the development and implementation of cross-functional claims payment improvements including standardization, controls and Provider/Vendor contract compliance.
- Oversees efforts to systematically collect, compile and report operational performance information, designs, implements and manages metrics and indicators to track performance to cost saving/avoidance goals and objectives.
- Works collaboratively with senior leadership to prepare and present on the progress of Payment Integrity capability-building, and metrics regarding overall Payment Integrity operations.
- Plans, develops, and directs activities relating to claims and internal performance data to meet corporate strategic goals.
- Identifies cost effective technologies, workflows and sourcing partnerships necessary to meet strategic commitments.
- Responsible for setting priorities for development deployments to enhance corporate ability to administer payment integrity of claims processes
- Responsible for the selection, development, motivation, appraisal and salary recommendations of reporting subordinates.
Attributes to success:
- Excited by building new things
- Curiosity and willingness to ask questions
- A deep desire to improve and make a change in the healthcare experience
- Preference towards collaboration and preventing silos
- You will roll up your sleeves and do whatever it takes to get the job done
- Ability to move fast and get things done
Desired skills and experience:
- Bachelors degree, MBA preferred with 5 years of experience in Healthcare, Consulting, or General Management or equivalent combination of education and experience.
- Prior experience at a payment integrity vendor a plus (Optum/Cotiviti/Equian)
- 2-3 years of SQL experience- focused on query development, basic analysis capabilities.
- Demonstrated managerial acumen, including the ability to set strategic goals and lead teams to effectively achieve them.
- Proven leadership competencies in designing, developing and implementing process structure, tools and measurement indicators that drive operational results.
- Ability to recognize process deficiencies and recommend and implement improvements.
- Proven ability to think analytically, apply analytical techniques and to provide in-depth analysis and recommendations to senior management using critical thinking and sound judgement.
- Strong communication and facilitation skills with all levels of the organization, including the ability to resolve complex issues, build consensus among groups of diverse stakeholders, manage strategic partner relationships, and effectively lead and engage internal teams in the fulfillment of roles and responsibilities.
- Proven experience in effectively managing service provider performance and delivery quality.
If you love running towards complex challenges and transforming them into solutions, if you want to make a potentially huge impact on many lives, and if you are looking for a disruptive startup with an inspiring and talented team, Devoted Health may be the place for you!
Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoteds Code of Conduct, our company values and the way we do business.
As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.
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