Sagility · 2 days ago
Associate Vice President - Payment Integrity Operations
United States
Full-time
Remote
Senior Level, Lead/Staff, Director/Executive
10+ years exp
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Responsibilities
Lead & oversee daily operations related to payment integrity, ensuring all functions are performed in compliance with relevant regulations, standards, and corporate policies.
Monitor and ensure the effective use of payment integrity technologies, including data analytics tools and automation solutions, to streamline operations.
Ensure timely and accurate resolution of payment discrepancies, disputes, and escalations, coordinating with internal teams and external stakeholders as needed.
Collaborate with other AVP’s to prioritize IT work, new audit implementations, new technology updates.
Define and execute strategies to enhance overpayments, accuracy of results, reduce overhead costs per recovery dollar, and mitigate financial risk in payment processes.
Drive initiatives to detect, investigate, and submit overpayments to clients Develop and implement process improvements to increase efficiency, accuracy, and compliance in payment integrity operations.
Use data analytics to identify trends, risks, and areas for improvement in payment processing and integrity.
Prepare and present regular reports and dashboards to senior leadership, highlighting performance metrics, issues, and opportunities for operational enhancement.
Ensure the development and maintenance of accurate documentation and reporting processes.
Ensure that all payment integrity activities comply with applicable healthcare regulations (such as HIPAA, Medicare/Medicaid guidelines, and payer contracts).
Monitor and audit payment processes to ensure adherence to internal policies and external regulatory standards.
Support internal and external audits related to payment integrity.
Stay informed about industry trends, regulations, and best practices to maintain compliance and enhance operational efficiency.
Develop and manage the budget for the Payment Integrity department, ensuring efficient allocation of resources.
Identify opportunities to optimize operational costs while maintaining high service quality and compliance standards.
Work with the technology team to automate wherever possible to reduce audit turn around times, improve quality and drive staff efficiencies.
Leverage payment integrity systems and software tools to track and monitor claims and payment discrepancies.
Collaborate with IT to ensure proper system functionality and data integration across platforms.
Utilize advanced Excel functions, SQL queries, or business intelligence tools.
Qualification
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Required
Bachelor’s degree in healthcare administration, Business, or a related field.
Master's degree preferred.
Understanding of claims processing and the lifecycle of a claim.
Minimum of 10-12 years of experience in healthcare, with focus on leading Operations within the Payment Integrity Vertical on Health Plan & Vendor.
Knowledge of healthcare economics.
Experience in directly interfacing with and managing clients.
Proficiency with payment processing systems, fraud detection tools, and data analytics platforms.
Advanced Excel skills and experience with reporting and business intelligence tools.
Strong leadership and team management skills, with the ability to inspire and develop a diverse team.
Deep knowledge of payment integrity concepts, fraud detection techniques, and cost containment strategies.
Expertise in using data analytics tools and automation technologies to drive operational improvements.
Strong understanding of compliance regulations and risk management practices.
Excellent communication and stakeholder management skills, with the ability to interact effectively at all levels of the organization.
Ability to manage complex projects and initiatives, delivering results within deadlines and budget.
Preferred
Large operational experience and exposure in Payment Integrity related business operations with a combination of Pre & Post Pay environment.
Someone who has layered understanding of Payment Integrity Technology/ Platform based solutions.
Benefits
Medical
Dental
Vision
Life Insurance
Short-Term and Long-Term Disability
Flexible Spending Account
Life Assistance Program
401K with employer contribution
PTO and Sick Time
Tuition Reimbursement
Company
Sagility
Sagility is a technology and a transformation company that provides BPM services for healthcare centers.
10001+ employees
Funding
Current Stage
Public CompanyTotal Funding
unknown2024-11-12IPO
2021-01-01Acquired
Leadership Team
Ramesh Gopalan
Group Chief Executive Officer
Recent News
Economic Times
2024-10-16
Company data provided by crunchbase
