Director Quality (Payment Integrity)

Cotiviti

4d•Remote

About The Position

The Director of Quality is responsible for ensuring quality delivery of the Payment Integrity Solution and driving excellence across multiple payment integrity products. This role will develop and implement a quality measurement framework, align quality processes across products, and establish monitoring mechanisms to communicate performance to senior leadership. The Director is focused on continuous improvement, delivering greater quality in support of Cotiviti’s growth strategy. Success in this role requires strong foundations in testing, technology, process management, operational acumen, and collaboration. The Director will engage with clients and internal teams to ensure the delivery of high-quality service, consistently achieve and surpass service level benchmarks, and effectively manage processes through frequent changes to meet SLA requirements.

Requirements

Bachelor’s degree in business, operations, healthcare or equivalent in a related field required and Master’s preferred
Minimum of five years’ management experience, ideally within the healthcare industry.
Demonstrated operational excellence, exceptional problem-solving ability, and proven people leadership skills.
Expertise in collaborating with key stakeholders and executive decision-makers.
Established leadership in directing operational divisions, shaping policies, practices, and achieving division objectives.
Highly developed interpersonal, analytical, and communication skills.
Proven track record of driving business improvement initiatives and delivering measurable outcomes.
Deep process-oriented expertise, with a focus on simplifying and scaling operations while maintaining superior quality.
Advanced technological proficiency, including experience in software development and payment integrity solutions.
Significant experience presenting to clients and senior leadership.
Skilled in responding to client requests for information, audits, and proposals.
Exceptional performance management skills demonstrated through outstanding team and organizational outcomes.
Ability to excel within fast-paced, highly accountable, and diverse environments, maintaining a strong client and customer service focus.
Extensive experience in strategic planning and operational development.
Renowned leadership qualities coupled with a history of successfully managing and developing high-performing teams.
Superior analytical and problem-solving capabilities, with a talent for diagnosing and resolving operational inefficiencies.
Excellent written and verbal communication skills, including public speaking experience.
Proficient in Microsoft Office Suite (Word, Excel, PowerPoint).
Professional integrity, with experience in appropriately handling confidential information.
Capable of working independently or collaboratively, effectively managing multiple priorities and meeting deadlines.
Experience operating in matrixed organizational structures.
Demonstrated ability to effectively manage stressful situations, including high volumes and frequent change.
Willingness to travel as business needs require.
Demonstrates flexibility and willingness to actively participate in the operations of an international organization, including attending conference calls scheduled to accommodate global time zones
Strong foundation in quality assurance and testing methodologies.
Experience designing and implementing quality measurement frameworks.
Demonstrated capability to align and standardize quality processes across a portfolio of products.
Expertise in establishing and maintaining mechanisms for performance monitoring and reporting to senior leadership.
A proven record in continuous improvement and elevating organizational quality outcomes.
Experience engaging with clients and internal teams to ensure consistent delivery of high-quality service.
History of persistently achieving and exceeding service level agreements (SLAs) and benchmarks.
Effective change management skills and adaptability amid frequent operational changes.
People leadership experience, with a focus on supporting organizational growth strategies.
Experience in process improvement within payment integrity or comparable environments.

Nice To Haves

Lean Six Sigma (Green Belt, Black Belt, or Master Black Belt)
Certified Quality Auditor (CQA) or Certified Manager of Quality/Organizational Excellence (CMQ/OE)
Project Management Professional (PMP)
Certified Professional in Healthcare Quality (CPHQ)
Certified Payments Professional (CPP)

Responsibilities

Oversee and drive quality performance across payment integrity solutions, ensuring continuous improvement and operational excellence.
Collaborate with cross-functional business units to measure, report, and enhance quality performance metrics and outcomes.
Develop and align best-in-class quality processes and standards, delivering exceptional results through operational excellence.
Work closely with Operations and Product teams to drive quality improvements by leveraging technology, optimizing processes, and developing talent.
Ensure timely and accurate responses for Payment Requests for Information (RFIs) and Request for Proposals (RFPs).
Support client intake requests for PrePayment Business Unit by understanding client requirements and providing tailored solutions and cost estimates.
Hire, develop, coach, and retain top-tier talent, fostering a culture dedicated to exceptional quality and customer satisfaction.
Optimize labor and operating expenses while increasing productivity, service quality, and supporting future client growth.
Lead and support operational improvement initiatives encompassing people, processes, and technology to deliver incremental value and operational efficiency, consistently meeting or exceeding service and quality goals.
Enforce Cotiviti’s intellectual property protection best practices throughout all operations.
Diagnose and resolve issues proactively, manage schedules, and ensure deadlines are met for timely completion of work.
Develop short-term and long-term plans to anticipate client needs and operational improvements.
Cultivate a positive workplace culture that supports corporate goals, promotes initiative, and fosters open communication at all organizational levels.
Collaborate and support business leaders throughout the organization, maintaining highly effective client and team dynamics in a collaborative environment.
Manage and delegate team and individual projects/assignments, and review performance against operating plans and standards.
Provide comprehensive reports and metrics to drive operational quality and inform strategic decisions, based on operational objectives and work plans at a senior level.
Build, maintain and influence strong relationships with executive leadership to support organizational goals.
Hire, develop, coach, lead and retain top-tier talent, with a focus on building and improving a team and culture that is able to assist in employing best in class practices to support and drive high levels of internal and external customer satisfaction.
Complete all responsibilities as outlined in the annual performance review and/or goal setting.
Complete all special projects and other duties as assigned.
Must be able to perform duties with or without reasonable accommodation.
This job description is intended to describe the general nature and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties and skills required. This job description does not constitute an employment agreement and is subject to change as the needs of Cotiviti and requirements of the job change.