Anticipated End Date: 2024-10-27
Position Title: Staff Vice President (VP) Payment Integrity (Edits)
Job Description:
Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights, formerly Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical-expense spending.
Location: Successful candidate must reside within 50 miles of an Elevance Health office location, and able to be in-office 3 days per week (hybrid).
Summary: Responsible for strategy development, execution, management, and compliance associated with prepay edits. Provides leadership, management, and vision necessary to maximize accurate edit execution while driving CoC, optimal edit performance, and emerging business growth opportunities.
Team Scope: 6 – 7 direct reports; 55+ indirect reports.
Position Responsibilities:
- Provides strategic vision, leads cross-functional engagement, and drives execution of edit strategy in support of multiple markets, products, and business opportunities.
- Ensures achievement of financial objectives and operational excellence. Provides strategic leadership for prepay programs, vendor management, operational performance, and administrative cost management.
- Determines strategy for technology enablement and process efficiencies to effectively meet goals and minimize administrative expense.
- Supports regulatory performance, reporting and audit processes.
- Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Position Requirements: Requires a BA/BS and minimum of 10 years’ experience in operational leadership and healthcare; or any combination of education and experience, which would provide an equivalent background.
Preferred Skills, Capabilities and Experiences: Background in Payment Integrity including understanding and knowledge of prepay edits preferred.
Corporate Title: Staff VP Cost Optimization
For candidates working in person or remotely in the below locations, the salary* range for this specific position is $158,960 to $286,128.
Locations: California; Colorado; District of Columbia (Washington, DC); Hawaii; Jersey City, NJ; Maryland; Nevada; New York; Washington State.
In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).
* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Job Level: Staff/Regional VP
Workshift:
Job Family: AFA > Financial Operations
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are: Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work: At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.
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