Payment Integrity Business Transformation Manager

Job Description

A bit about this role: 

Our Payment Integrity Department ensures that provider claims are paid correctly by the responsible party, for eligible members, according to contractual terms, not in error or duplicate, and free of wasteful or abusive practices. As part of this function, the Implementation Manager is responsible for ensuring successful execution of Payment Integrity (PI) programs and processes.  

The ideal candidate is a self-starter who enjoys solving complex operational problems, implementing new processes from start to finish, and driving impact in close collaboration with cross-functional stakeholders. In addition to workflow redesign, this person will dive into issue triage, escalation, and resolution. 

Your Responsibilities and Impact will include: 

• Actively triage, investigate and resolve operational issues and escalations to ensure timely and accurate resolution 

• Identify root cause drivers and implement solutions that address issue recurrence and continuously improve processes

• Collaborate closely with technical, auditing, and business teams to address operational gaps and improve/scale workflows

• Support teams in learning new processes, providing guidance and helping to troubleshoot where needed

• Regularly analyze performance data, provide insights and drive action to address bottlenecks and improve productivity, accuracy, and compliance 

Required skills and experience: 

• Thrives in operational execution, escalation management, and problem-solving

• Comfort with ambiguity, including unanticipated and sometimes messy issues that require ownership from triage to resolution

• Analytic mindset and ability to execute qualitative and quantitative analyses that drive impact

• Results-oriented, with a willingness to take initiative and get into details to get the job done

• Exceptional communication and cross-functional collaboration skills, with an ability to influence others

• Strong organizational skills, including prioritizing and managing multiple initiatives at once

• High degree of professionalism

Desired skills and experience: 

• 5+ years of operations experience (Medicare Advantage health plan and/or startup a plus)

• Strong desire and ability to quickly learn Payment Integrity concepts and workflows

• Experience influencing and driving change in a highly-matrixed organization

• Experience with tech and data teams a plus

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Salary Range: $95,000 - $120,000 /year

Our ranges are purposefully broad to allow for growth within the role over time. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered may depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.

Our Total Rewards package includes:

• Employer sponsored health, dental and vision plan with low or no premium

• Generous paid time off

• $100 monthly mobile or internet stipend

• Stock options for all employees

• Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles

• Parental leave program

• 401K program

• And more....

*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.

Healthcare equality is at the center of Devoted’s mission to treat our members like family.  We are committed to a diverse and vibrant workforce. 

At Devoted Health, we’re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That’s why we’re gathering smart, diverse, and big-hearted people to create a new kind of all-in-one healthcare company — one that combines compassion, health insurance, clinical care, service, and technology - to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. Founded in 2017, we've grown fast and now serve members across the United States.  And we've just started. So join us on this mission!

Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values and the way we do business.

As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.