Director, Itemized Bill Review

Zelis•St. Petersburg, FL

7d•Hybrid

About The Position

The Director, Itemized Bill Review (IBR) is responsible for the strategic leadership, operational performance, innovation, and growth of the Itemized Bill Review solution across the Expert Claims Review business. This role serves as the enterprise leader for IBR, accountable for product performance, operational execution, quality outcomes, client value realization, and future-state solution development. The Director leads a globally distributed team across the United States and India, providing leadership for coding operations, quality programs, innovation initiatives, and operational excellence. This role partners closely with Product, Technology, Analytics, Operations, Sales, Client Management, and Implementation leadership to define and execute the long-term vision for IBR. As the senior business owner for the IBR solution, the Director is responsible for advancing automation, artificial intelligence, machine learning, workflow modernization, and new savings opportunities that improve scalability, coding accuracy, operational efficiency, and client outcomes. The role translates reimbursement trends, coding updates, market demands, and client needs into strategic initiatives that strengthen the IBR value proposition and support enterprise growth objectives.

Requirements

Current coding certification required (CPC, CCS, RHIT, RHIA, or equivalent).
10-12+ years of experience in coding review, itemized bill review, reimbursement integrity, payment integrity, or related healthcare functions.
5+ years of progressive leadership experience leading managers, supervisors, or large operational teams.
Demonstrated experience leading operational transformation, automation, AI-enabled initiatives, or technology modernization efforts.
Deep understanding of payer reimbursement methodologies, coding guidelines, healthcare claims, and payment integrity programs.

Nice To Haves

Experience leading globally distributed teams.
Experience supporting automation, artificial intelligence, machine learning, or advanced analytics initiatives.
Experience influencing product strategy, technology investments, and operational transformation programs.
Experience supporting large-scale healthcare payer or payment integrity organizations.

Responsibilities

Own the strategic direction, growth, and performance of the Itemized Bill Review solution across all clients and lines of business.
Achieve savings, revenue, and productivity targets for the solution.
Develop and execute multi-year business plans that support organizational growth, client value, operational scalability, and product innovation.
Establish, monitor, and report on key performance indicators (KPIs) and operational, financial, quality, and client performance metrics, utilizing data-driven insights to identify opportunities, mitigate risks, and drive achievement of strategic and operational goals.
Partner with executive leadership to identify new savings opportunities, growth initiatives, and competitive differentiation strategies.
Translate coding, reimbursement, regulatory, and market trends into strategic business recommendations and future-state product capabilities.
Lead the identification, prioritization, and implementation of AI, machine learning, and automation opportunities across the IBR solution.
Partner with Product, Technology, and Analytics teams to modernize IBR workflows and improve scalability, productivity, coding accuracy, and savings capture.
Drive the development of technology-enabled review methodologies that reduce manual effort while maintaining quality and compliance standards.
Establish a multi-year innovation roadmap for the IBR solution aligned with enterprise automation and digital transformation objectives.
Evaluate emerging technologies, coding intelligence tools, and reimbursement analytics capabilities to improve operational performance and client outcomes.
Lead and develop a globally distributed team across the United States and India, ensuring operational consistency, workforce planning, talent development, and scalability.
Establish performance management frameworks, quality standards, and operational governance processes that support business growth.
Drive continuous improvement initiatives that improve productivity, savings outcomes, quality performance, and turnaround times.
Foster a culture of innovation, accountability, collaboration, and continuous learning across global teams.
Ensure effective resource allocation and organizational structures to support strategic priorities and future growth.
Serve as the executive business owner and strategic stakeholder for IBR product enhancements, automation initiatives, technology investments, and platform modernization efforts.
Partner with Product leadership to prioritize investments that improve operational efficiency, savings performance, client outcomes, and scalability.
Drive the identification, development, and implementation of new coding concepts, reimbursement methodologies, and savings opportunities.
Provide strategic oversight for automation, machine learning, advanced analytics, and workflow transformation initiatives.
Serve as executive sponsor and subject matter expert for strategic client engagements, implementations, escalations, and growth initiatives.
Partner with Sales, Client Management, and Implementation teams to support client retention, expansion opportunities, and new business growth.
Identify emerging market opportunities and trends that strengthen the IBR solution and drive measurable client value.
Represent the IBR solution during executive client presentations, strategic business reviews, and industry discussions.
Leverage operational, coding, and financial data to identify trends, risks, and opportunities.
Drive data-informed decision-making through savings analytics, quality metrics, operational reporting, and client trend analysis.
Partner with Analytics and BI teams to develop enhanced reporting capabilities and actionable business insights.
Ensure effective measurement and reporting of business outcomes, operational performance, and value realization.
Maintain enterprise oversight of coding compliance, quality standards, audit methodologies, and reimbursement integrity.
Ensure adherence to HIPAA, Official Coding Guidelines, AHA Coding Clinic, CPT Assistant guidance, and organizational policies.
Establish governance frameworks that support consistency, accountability, risk mitigation, and operational excellence.
Ensure quality assurance programs support scalable, repeatable, and high-confidence review outcomes.