Director, Payment Integrity Client and Provider Services Operations

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development. 

Summary

Leads the Payment Integrity Client and Provider Services Operations teams to ensure compliance and adherence with key client deliverables and contractual Service Level Agreements. Work with internal teams to ensure revenue forecast projections are met or exceeded.  Establish departmental processes and procedures to maximize productivity and performance.

Your role in our mission

• Leader of Payment Integrity operations and call center teams, reporting to the Sr. Director of Operations, ensuring efficiency and service quality
• Understands and provides operational expertise for the breadth of Payment Integrity audit strategies and supporting operations.
• Payment Integrity revenue forecast analysis and operational team oversight to ensure revenue forecast projections are met or exceeded.
• Monitor performance metrics, including client satisfaction, response times, and resolution rates, to ensure targets are met
• Reviews, analyzes, and evaluates business procedures to identify sources of revenue and cost reduction strategies through process improvements, new initiatives, automation, and strategic agendas/oversight
• Implements policies and procedures that will improve day to day operations and maximize company productivity, performance, and service quality
• Ensure compliance and adherence with key client deliverables and contractual Service Level Agreements  
• Identifies, performs root cause analysis, and develops immediate action plans impacting operational performance
• Set the vision and direction for the call center to drive performance and ensure a high level of customer satisfaction
• Advanced ability to manage projects with demonstrated knowledge and experience in project management techniques, software, and tools
• Develops and presents reports and other written communication to the client, partnered with Account Management, to ensure client satisfaction and operational excellence
• Interacts with executives and supporting staff
• Supports collaboration and communicates broadly to ensure overall coordination of goals and objectives between internal teams such as Account Management, IT, Implementation, Sales, Product, and other key internal stakeholders.
• Responsibility for overseeing hiring, training, development, and performance management

What we're looking for

• Eight or more years experience in Payment Integrity Audit and Recovery with knowledge of audit strategies such as Data Mining, Clinical Medical Record Review, and Bill Audit
• Eight or more years experience in a senior management capacity for operations and call center, preferably in a Payment Integrity market
• Five or more years experience working collaboratively with multiple organizational departments, including Information Technology
• Ability to present and communicate ideas clearly and persuasively at all levels to both internal and external audience, including executive levels 
• Strong leadership, project management, and process optimization skills

What you should expect in this role

• This role is 100% remote, based in the U.S.

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