Director, Payment Integrity Program Development

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!

Job Description

A bit about this role:

At Devoted, we know that one of the most important ways we will build

trust with our network of providers and members is to pay claims

accurately and on time while having transparent payment policies. 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 a Payment Integrity Program Development Director, you will be

accountable for identifying and researching new medical cost savings

opportunities, developing short and long term solutions, and organizing

stakeholders to make “buy vs. build” decisions. You will assess new

opportunities by leveraging your subject matter expertise, researching

and evaluating CMS policies and industry trends, analyzing Devoted

claims performance, and collaborating internally with Finance, Medical

Economics, Network Management, Claims, and other experts and Senior

Leaders at Devoted.

Your Responsibilities and Impact will include:

• Identify, research, size, and develop new medical cost savings

• opportunities

• Leverage your subject matter expertise, policy research, industry trends, and internal and publicly available data to generate ideas

• Develop relationships and collaborate with internal stakeholders to collect ideas, align on goals, and develop solutions that bring most value while avoiding network disruption

• Use data and research to influence Senior Leadership to develop new strategies and policies

• Develop KPIs and reporting to track progress and provide transparency to Senior Leadership

• Collaborate with Operations and R&D to make “buy vs. build” decisions and oversee the process from ideation to development

• Build out and oversee the Payment Integrity Ideation Team

Required skills and experience:

• Bachelor's degree and a minimum of 6 years of relevant experience

• Understanding of US healthcare

• Knowledge of claims adjudication, revenue cycle management, and payment integrity

• Experience using data to inform ideation and strategy towards medical cost savings opportunities

• Proficiency in a variety of analytical and data mining tools to generate and analyze data sets

• Ability to collaborate, communicate, and influence horizontally and vertically

• Being comfortable in both leadership and execution roles

• Being comfortable with ambiguity and startup environment

• Ability to incorporate company vision, mission, and values in decision making

Desired skills and experience:

• Proficiency with SQL

• People management experience

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Salary Range: $164,000 - $228,000 / 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,