Sr. Manager Payment Integrity Strategy and Operations

• Leading The Process Leaders/Process Stewards In Planning, Defining, Developing, Testing, Documenting, Analyzing Results And/Or Implementing Process Improvement And Process Reengineering Opportunities
• Leading And Supporting Business Process Activities And Methods To The Super Process Leaders/Process Steward
• Leading Team Activities, Deliverables, And Issue Resolution
• Leading Key Activities Including Data Collection, Metric Definition And Analysis, And Root Cause Analysis
• Supporting Development And Evolution Of Hcsc Business Process Management Methodology Identifying Best Practice Standards, Guidelines, Procedures And Tools For Analyzing, Designing, And Implementing Business Process Initiatives
• Ability To Travel.

• Bachelor’s degree and 8 years of experience in health care quality improvement, health care accreditation, health care operations, or combination thereof OR 12 years of experience in health care quality improvement, health care accreditation, health care operations, or combination thereof, including 8 years of experience in the health insurance industry with large, multi-state payer(s)
• 3 years of leadership or management experience
• Experience with Continuous Quality Improvement (CQI) concepts, Strategy, and Change Management concepts
• Experience with external accrediting agency requirements (i.e., NCQA, URAC, AAAHC) and history of success in achieving accreditation
• Experience providing support to senior-level staff in process re-engineering and strategic problem-solving
• Analytical skills and negotiation skills
• Verbal and written communication skills including leadership skills, organizational skills and detail-orientation, interpersonal skills, consensus building skills, professional presentation skills and decision-making skills
• Experience preparing documentation for auditors or project management
• Knowledge and understanding of the health care industry and regulatory requirements
• Experience writing policies and procedures
• Written and verbal communication skills
• Ability and willingness to occasional travel.

Payment integrity operational processes and strategy