Payment Integrity Escalations Director

CVS Health•Plymouth, VT

2d•Hybrid

About The Position

The Lead Director Payment Integrity Escalations and Rework oversees the implementation of the process improvement strategy as it pertains to Payment Integrity and its impact on re-work and responsible for creating a Payment Integrity Escalations process that aligns with the broader Service Operations Escalation process. This leader will leads teams in the identification and resolution of process issues, re-work initiatives and serves as the main point of contact/liaison for internal and external customers as it pertains to Payment Integrity Escalations.

Requirements

10+ years work experience in standing up new products / processes
5 years of experience in claims re-work
10 years of experience of escalation management / oversight

Nice To Haves

5+ years experience in working with healthcare providers
Comfortable working in high pressure environments

Responsibilities

Communicates with top management on the dynamics of the end-to-end processes and uncovers opportunities related to Payment Integrity & Re-work resolution
Communicates strategically across business units to understand business priorities, goals, and success measures.
Contributes to business objectives and develops documentation for business process requirements that support department needs for creating and executing on an escalation process / pathway.
Contributes to top-level decision making on process design to enhance productivity and ensure clarity in process execution.
Responsible for understanding Payment Integrity claim lifecycle to help leaders examine workflows and systems to identify bottlenecks and inefficiencies.
Designs (or participates in design) performance indicators to enable data-driven decision making around escalations and re-work.
Determines potential process improvements based on department needs; considers technology solutions to streamline new processes.
Develops risk management processes to identify potential risks and ensure adherence to legal and regulatory compliances
Develops a cross-functional high performing team of department heads, experts, and external partners to align processes across different functions to achieve organizational objectives.