Business Change Director - Payment Integrity Ideation

About This Role

This role is responsible for directing changes through the ideation and implementation of projects and programs to support business goals related to payment integrity. The director will focus on identifying new audit concepts by leveraging data models, research, and publicly available information to recover and prevent unnecessary medical expenses.

Responsibilities

• Identify and implement varied projects, programs, and plans that support achievement of business unit and enterprise goals
• Specialize in organization effectiveness areas like planning, project portfolio, or culture/change, ensuring alignment with corporate strategy
• Identify potential issues, project change, and scope data
• Lead efforts to identify best practices
• Develop and design processes and systems that support business needs
• Designs methods for integrating functions and processes
• Conduct cost/benefit analyses
• Build support for business change throughout the business unit
• Develop new audit concepts through data models, CMS and state Medicaid guidelines, researching provider billing trends, and other publicly available information
• Create/audits reports and paid claims to identify overpayment of claims across various lines of business

Requirements

• 10+ years managing mid to large-scale change/project initiatives
• Advanced understanding of the healthcare industry

Qualifications

• BA/BS in a related field
• Minimum of 10 years managing mid to large-scale change/project initiatives

Nice to Have

• Proven track record of delivering results in creating new payment integrity overpayment ideas and concepts
• Knowledge of planning models and methodology
• Project management experience
• Change management experience (strategic and execution)
• Master's degree

Benefits

Certifications