Director Payment Integrity Analytics

View Moreicons; Northern (KY); Hybrid; USD 140,000 - 190,000; Full time

Job summary

Sagility is seeking a Director of Payment Integrity Analytics to lead data reporting, analytics architecture, and client data integrity practices. You will partner with developers to align data models for analytic, product, and service requirements in a remote role based in the United States.

You will guide end-to-end implementations, oversee budgets and resources, and ensure timely, high-quality deliverables while promoting a strong client onboarding experience and savings realization.

Qualifications

• Bachelor's Degree / MBA or 8+ years of relevant experience in Payment integrity.
• 8+ years’ experience in end to end new client implementations on data mining/clinical/coding programs
• Exposure to budget, forecast and resource management
• Knowledge of Project management methodologies such as Agile, Waterfall

Responsibilities

• Build and implement an effective implementation process and framework for PI audit programs.
• Develop a timely onboarding experience for clients to realize savings quickly.
• Manage cross-functional teams across data mining, clinical, and DRG/audit domains.
• Prepare executive status reports and project communications.
• Maintain project management tools and resource trackers.
• Identify and mitigate risks and issues across multiple projects.

Skills

Budget management

Agile

Waterfall

Communication

Interpersonal skills

Team player

Adaptability

Data confidentiality

Education

Bachelor's or MBA in related field / 8+ years in payment integrity

Tools

Power BI

Tableau

SharePoint

MS Visio

MS Project Plan (MPP)

MS Office (Excel/Word/PP)

Job description

Explore meaningful roles that let you make an impact in healthcare while growing your career with purpose, innovation, and global opportunities.

Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees across 5 countries.

Job title: Director Payment Integrity Analytics

Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees across 5 countries.

Job Description:

Develop data reporting and client data integrity practices and analytic data architecture. Partner with application developers to ensure optimized data model alignment to support all analytic, product, and service requirements.

Advanced knowledge of database development and data model architecture in SQL

Advanced knowledge of payment integrity data requirements and application of claim adjustment logic to client claims data sets.

Intermediate level of experience with MS Office - Excel, Word, MS PowerPoint, MS Vision
Shows intermediate skills in power BI, Tableau and advanced skills in SharePoint, Microsoft Project Plan (MPP)

Education:

• A Bachelor's Degree / MBA or 8 + years of relevant experience in Payment integrity

Experience:

• 8+ years’ experience in end to end new client implementations on data mining/clinical/coding programs

Mandatory Skills:

• Effective handling of highly sensitive, and often highly confidential, information using exemplary judgment, tact and diplomacy
• Exposure to budget, forecast and resource management
• Knowledge of Project management methodologies such as Agile, Waterfall
• Good written/ verbal communication including effective interpersonal skills
• Proven interpersonal skills while contributing to team effort by accomplishing related results as needed
• Must be a team player and adaptable to a dynamic work environment

Preferred Skills:

• Intermediate level of experience with MS Office - Excel, Word, MS PowerPoint, MS Visio
• Shows intermediate skills in power BI, Tableau and advanced skills in SharePoint, Microsoft Project Plan (MPP)

Roles & Responsibilities:

• This role is to build and implement an effective implementation process and framework for PI audit programs (Datamining and Clinical) and the major functions in the end to end cycle leveraging an integrated PI technology platform to understand the tasks involved related to client implementations.
• One of our key goals of this role is to offer our clients' an excellent on-boarding experience in a timely manner for quick realization of savings

Key Responsibilities:

• Should have set up and led high performing teams with cross- functional experience in implementation of end to end Payment Integrity programs in both Pre Pay and Post Pay not limited to Data Mining, DRG, Home Health, SNF, HCD/DME audit types
• Monitor onboarding and off boarding of resources activity including access management
• Support Artifact / Deliverable Management processes, including:
• Monitoring and reporting timely submission of client deliverables
• Collation and initial quality review of deliverables for submission
• Maintain process documents and template updates
• Maintain and configure Project Management tools
• Maintain resource trackers and other forecast information of the project
• Assist project teams with the timely identification, management and resolution of action items, risks, and issues
• Prepare executive status reports with high level of accuracy
• Independently prepare project and program communications
• Participate and prepare materials for meetings
• Monitor Quality Assurance Activities like adherence to compliance items and elevate risks/ issues to team leader
• Review time reports and follow up with any resources to ensure that any missing time is captured and recorded correctly
• Work plan management across multiple projects
• Work on ad-hoc tasks as directed by leadership, in a timely manner with high level of accuracy
• Assists project teams with timely identification, management and resolution of action items, risks, and issues

The above statements are intended to indicate the general nature and level of work being performed by employees within this classification. They are not intended to be an exhaustive list of all responsibilities, duties and skills required of employees assigned to this job. Employees in this job may perform other duties as assigned

Sagility is an Equal Opportunity Employer/Vet/Disability.

Location: Work@Home USAUnited States of America