Director - Payment Integrity Transformation

Sagility

1d•Remote

About The Position

Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees across 5 countries.

Requirements

A Bachelor's Degree / MBA
8 + years of relevant experience in Payment integrity
10+ years’ experience in end to end new client implementations on data mining/clinical/coding programs
Effective handling of highly sensitive, and often highly confidential, information using exemplary judgment, tact and diplomacy
Exposure to budget, forecast and resource management
Knowledge of Project management methodologies such as Agile, Waterfall
Good written/ verbal communication including effective interpersonal skills
Proven interpersonal skills while contributing to team effort by accomplishing related results as needed
Must be a team player and adaptable to a dynamic work environment

Nice To Haves

Intermediate level of experience with MS Office - Excel, Word, MS PowerPoint, MS Visio
Intermediate skills in power BI, Tableau
Advanced skills in SharePoint, Microsoft Project Plan (MPP)

Responsibilities

Build and implement an effective implementation process and framework for PI audit programs (Datamining and Clinical) and the major functions in the end to end cycle leveraging an integrated PI technology platform to understand the tasks involved related to client implementations.
Offer clients an excellent on-boarding experience in a timely manner for quick realization of savings.
Set up and led high performing teams with cross-functional experience in implementation of end to end Payment Integrity programs in both Pre Pay and Post Pay not limited to Data Mining, DRG, Home Health, SNF, HCD/DME audit types.
Monitor onboarding and off boarding of resources activity including access management.
Support Artifact / Deliverable Management processes, including: Monitoring and reporting timely submission of client deliverables, Collation and initial quality review of deliverables for submission.
Maintain process documents and template updates.
Maintain and configure Project Management tools.
Maintain resource trackers and other forecast information of the project.
Assist project teams with the timely identification, management and resolution of action items, risks, and issues.
Prepare executive status reports with high level of accuracy.
Independently prepare project and program communications.
Participate and prepare materials for meetings.
Monitor Quality Assurance Activities like adherence to compliance items and escalate risks/ issues to team leader.
Review time reports and follow up with any resources to ensure that any missing time is captured and recorded correctly.
Work plan management across multiple projects.
Work on ad-hoc tasks as directed by leadership, in a timely manner with high level of accuracy.
Assist project teams with timely identification, management and resolution of action items, risks, and issues.