Manager - Payment Integrity Prospective Editing

Job Description

Responsible for planning, organizing and managing an assigned business unit. Operate within broad objectives to ensure optimum utilization of resources; adapt business unit plans and priorities to address resource and operational challenges. Evaluate policies, procedures and business unit goals to make decisions and solve problems.

• Manage activities of a department including, but not limited to planning, problem solving, staff development and communication.
• Manage the evaluation of new and existing business processes to identify areas of opportunity and execute on business unit objectives, supporting continuous improvement.
• Lead, direct, evaluate and develop the work of assigned employees.
• Responsible for special projects, programs and initiatives to ensure successful delivery of business outcomes.
• Provide effective and efficient solutions to complex business problems
• Ensure that day to day business unit operations align with organizational objectives.

"Qualifications"

• Bachelor's Degree in a related field is required. Master's Degree in a related field is preferred.
• Five (5) years of experience in a related field is required.
• Previous experience leading projects and/or teams is required.
• Ability to effectively lead, coach and develop team members.
• Ability to work effectively in a team environment.
• Strong organizational, planning, analytical, and problem-solving skills.
• Working knowledge of corporate organizational structures, including functional responsibilities.
• Strong verbal, written communication and interpersonal skills.
• Ability to manage multiple priorities concurrently.
• Ability to solve practical problems and deal with moving variables in situations with limited standardization and alignment.
• Ability to interface and present to all levels of the organization.
• Ability to build relationships and work collaboratively with cross-functional teams.

Departmental Preferences:

• Six Sigma certification with an understanding of LEAN processes.
• Knowledge of the Healthcare industry, major healthcare entities, Member/Eligibility, and claims lifecycle.
• Experience with Payment Integrity business, Health Technology, or Healthcare Financial Services.
• Demonstrated ability to identify and lead growth activities through optimization, improvement, and transformation.
• Experience in driving affordability and medical spend avoidance programs.
• Demonstrated ability to manage large-scale complex programs within a matrix environment.

All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability.