Senior Director, Payment Operations

Collective Health•Lehi, UT

2d•Hybrid

About The Position

At Collective Health, we’re transforming how employers and their people engage with their health benefits by seamlessly integrating cutting-edge technology, compassionate service, and world-class user experience design. As the Senior Director of Payment Operations at Collective Health, you will hold a key leadership position responsible for driving the strategic direction and operational excellence of our Payment and Stop-Loss operational functions. You will collaborate closely with cross-functional teams to ensure the seamless integration and operations of our Provider Payment, Provider Recoupment, Client consolidated billing, and Stop-Loss policies, processes, and systems upholding the highest standards of quality and compliance. You will be working with a multidisciplinary team encompassing product and engineering to help implement new products and system enhancements. You will play a critical role in ensuring operational excellence, enhancing client satisfaction, and maintaining compliance with state and federal regulations.

Requirements

Bachelor's degree in Accounting and Finance, Healthcare Administration, Business Administration, or a related field; Master's degree preferred.
Minimum of 10+ years of experience in healthcare payment operations or related roles, with a strong understanding of provider payment and recoupment processes, remittance advice, EDI standard processes (ANSI 835), Client billing, Vendor management and stop-loss systems, plan policies, and payment integrity/cost containment principles.
Proven leadership experience managing multidisciplinary teams, with a focus on driving operational excellence, fostering innovation, and achieving results.
Strong analytical and problem-solving skills, with the ability to analyze complex data, identify trends, and make data-driven decisions to optimize payment and stop-loss operations and systems.
Excellent communication and collaboration skills, with the ability to effectively engage and influence stakeholders at all levels of the organization.
Experience working in a fast-paced, dynamic environment, with the ability to manage competing priorities and drive projects to completion within established timelines.
Knowledge of healthcare regulations, compliance requirements, and industry best practices related to payment,stop-loss, and payment integrity.
Passion for healthcare innovation and a commitment to driving positive change in the industry.
Operational management with provider payment and Client billing operational leadership in a health insurance environment

Nice To Haves

Certification in compliance and regulatory
Stop Loss/ reinsurance knowledge
Process improvement certifications (i.e. Lean Six Sigma)

Responsibilities

Provide strategic direction and vision for the Provider Payment, Provider Recoupment, Client Billing and Stop-Loss teams, aligning with Collective Health's goals and objectives, and driving initiatives to enhance operational efficiency, effectiveness, and scalability.
Identify both near-term and long-term strategic opportunities that span customer experience, operational processes, technology, automation, and risk management
Drive execution against strategic priorities with urgency, prioritize and sequence strategic transformation to realize opportunities identified, pivoting as needed.
Partner with Product and Engineering leadership to execute short and long term strategies enabled by technology
Develop and deliver success measurements and sustainability plans
Lead broad, multidisciplinary stakeholder management
Lead initiatives to ensure payment accuracy, prevent fraud, waste, and abuse, and implement cost containment strategies to optimize claims expenditures while maintaining high-quality care delivery.
Accountable for driving results that meet performance KPIs
Responsible for direct leadership of Provider payment, Provider Recoupment, Client billing, and Stop-Loss operations, products, and systems.
Lead and mentor a diverse team of provider payment specialists, client billing specialists and Stop-Loss operations professionals, fostering a culture of collaboration, innovation, and continuous improvement, and promoting individual growth and development.
Establish and maintain quality assurance processes and protocols to ensure the accuracy, integrity, and compliance of Provider payment, Client billing, and Stop-Loss operations, with a focus on minimizing errors and improving client satisfaction.
Ensure Provider payment, Provider Recoupment, Client billing, and Stop-Loss operations and systems meet regulatory requirements, accreditation standards, and data security best practices, implementing appropriate controls and safeguards to mitigate risks.
Ensure compliance with Provider payment, Provider Recoupment, Client billing, and stop-loss client contractual policies and regulatory requirements, collaborating with internal stakeholders and external partners to implement and maintain policy updates.
Collaborate with product development, commercial, legal, data analytics, finance, and other cross-functional teams to drive alignment, integration, and operational improvements with broader organizational objectives and initiatives.