Director of Payment Integrity & Compliance

Bazeta; Columbus (OH); Híbrido; USD 130.000 - 180.000; Jornada completa

Descripción de la vacante

SIHO is seeking a Director of Payment Integrity to lead the Quality Assurance, Grievances & Appeals, and Fraud, Waste & Abuse teams, shaping strategy and supervising daily operations.

You will translate federal and state regulations into practical processes, drive continuous improvement, and partner with Legal, Compliance, and external stakeholders to ensure CMS alignment and accurate reporting. Strong leadership and analytical skills are essential.

Formación

• Bachelor's degree in a related field or equivalent work experience.
• Strong understanding of federal and state regulations governing grievances and appeals.
• Proven ability to lead and develop teams in a managed care environment.
• Excellent written and verbal communication skills with all levels of stakeholders.

Responsabilidades

• Directly supervise and manage QA, Grievances & Appeals, and FWA teams with day-to-day oversight.
• Translate CMS and state regulatory requirements into actionable process changes.
• Monitor and improve grievances and appeals processes for ongoing compliance.
• Collaborate with Legal and Compliance on external inquiries and audits.
• Lead data-driven analysis to identify trends and opportunities for cost savings.
• Oversee vendor interactions and ensure data transfers meet quality standards.

Conocimientos

Excel proficiency

Regulatory compliance

Leadership

Communication skills

Educación

B.S. in healthcare operations or equivalent

Herramientas

HSP claims system

Descripción del empleo

SIHO is seeking a Director of Payment Integrity to lead the Quality Assurance, Grievances & Appeals, and Fraud, Waste & Abuse teams, shaping strategy and supervising daily operations.

You will translate federal and state regulations into practical processes, drive continuous improvement, and partner with Legal, Compliance, and external stakeholders to ensure CMS alignment and accurate reporting. Strong leadership and analytical skills are essential.