Lead Director, Business Consulting/Payment Integrity

CVS Health•Hartford, CT

4d•$100,000 - $231,540

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. The Lead Director role is responsible for leading the execution, and governance of initiatives that advance the data mining and editing capabilities across prepay and post- pay. This leader will oversee the execution of initiatives focused on leading efforts to modernize editing capabilities, expanding internal editing solutions, implementing new technologies, optimizing relationships across multiple organizations, vendors and improving the overall datamining and editing solutions. The role serves as the primary lead for complex cross-functional initiatives spanning business operations, analytics, technology and configuration. The Lead Director will collaborate with executive leadership to develop and execute strategic roadmaps, prioritize initiatives, measure business outcomes, and ensure successful delivery of high-impact datamining and editing solutions that improve payment accuracy, reduce administrative cost, enhance provider experience, and generate measurable medical cost savings.

Requirements

8+ years of progressive leadership experience in healthcare operations, Payment Integrity, claims editing, healthcare analytics, consulting, or strategic program management.
Demonstrated experience leading large enterprise transformation initiatives across multiple business and technology organizations.
Experience managing complex cross functional programs involving business operations, IT, clinical teams, analytics and external vendors.
Strong knowledge of healthcare claims processing, payment integrity, claims editing, pre-pay and post-pay programs or healthcare reimbursement.
Experience developing executive-level presentations, business cases, roadmaps, and strategic recommendations.
Experience with measuring ROI, operational performance, and business outcomes.
Experience leading managers and high-performing team.
Ability to lead large-scale implementation and change management.

Nice To Haves

Experience with Payment Integrity editing platforms such as Lyric, Cotiviti, PPM or similar claims editing solutions.
Knowledge of SQL, healthcare data analytics, provider billing practices, or payment policy.
Experience building governance framework, operational metrics and measurements.
Demonstrated success leading enterprise modernization initiatives.

Responsibilities

Lead strategic initiatives across Payment Integrity data mining and editing team
Develop and manage multi-year strategic roadmaps supporting internal editing expansion and vendor optimization.
Drive implementation of enterprise editing platforms including Lyric, internal editing solutions, and future technologies.
Lead cross-functional teams responsible for business requirements, implementation planning, operational readiness, and deployment.
Partner with technology, analytics, clinical, service operations, compliance, and vendor organizations to successfully deliver complex programs.
Measure initiative performance through defined KPI's including implementation timelines, quality, financial impact, operational performance, and savings realization.