WARNING: Please beware of phishing scams that solicit interviews or promote work-at-home opportunities, some of which may pose as legitimate companies. Elevance Health requires a completed online application for consideration of employment for any position. We will never ask you for a credit card, send you a check, or ask you for payment as part of consideration for employment.Staff VP Payments Integrity Operations
Job Family: Customer Care
Type: Full time
Date Posted:Feb 29, 2024
Anticipated End Date:Apr 07, 2024
Reference: JR106438
Location:
IN, INDIANAPOLIS
CA, WOODLAND HILLS
WI, Waukesha
NJ, MORRISTOWN
FL, MIAMI
TN, MEMPHIS
OH, CINCINNATI
CA, WALNUT CREEK
KY, LOUISVILLE
LA, BATON ROUGE
NY, NEW YORK
WA, SEATTLE
NH, MANCHESTER
TX, GRAND PRAIRIE
IL, CHICAGO
CA, RANCHO CORDOVA
MI, DEARBORN
TN, NASHVILLE
MN, GILBERT
LA, METAIRIE
NY, MIDDLETOWN
AR, LITTLE ROCK
DC, WASHINGTON
NV, LAS VEGAS
TX, HOUSTON
MN, MENDOTA HEIGHTS
TN, KNOXVILLE
VA, NORFOLK
MO, SPRINGFIELD
MO, COLUMBIA
CA, LOS ANGELES
CT, WALLINGFORD
MO, ST LOUIS
CA, COSTA MESA
MD, HANOVER
FL, TAMPA
NJ, ISELIN
WV, CHARLESTON
NE, LINCOLN
OH, MASON
OH, SEVEN HILLS
RI, SMITHFIELD
CO, DENVER
North Carolina, Cary
CA, PALO ALTO
ME, SOUTH PORTLAND
NC, WINSTON
GA, ATLANTA
NY, LATHAM
OH, COLUMBUS
VA, RICHMOND
NE, OMAHA
IA, W DES MOINES
VA, ROANOKE
CO, COLORADO SPRINGS
DescriptionA proud member of the Elevance Health family of companies, Carelon Global Solutions, formerly Legato Health Technologies, is a managed service delivery organization, providing information technology and business operations services for health plans.Staff VP Payments Integrity OperationsLocationWithin 50 miles, and commutable at least 3 days/week to an Elevance Health officeSummaryThe Staff VP Payment Integrity leader within Carelon Global Solutions will drive a clear objective of providing dedicated leadership to its Payment Integrity Unit and overseeing the integration and management of the overpayment recovery lifecycle and delivery of Carelon’s Payment Integrity Solutions and Services to both our internal Elevance clients as well as external clients.The Staff VP of Payment Integrity role offers a unique opportunity to drive the strategy of our Carelon Global Solutions business segment. You will help lead us into the future. It is a key leadership role in collaborating with the Growth Office to drive Revenue within Carelon.The successful candidate will participate in developing Carelon’s global and domestic market strategies for the respective business unit, providing key input and management.To excel in this position, the candidate must have exceptional experience in the integration and management of the overpayment recovery lifecycle, including concept identification and validation, provider solicitation, claims adjustments, collections, and inquiry & disputes.Candidates should demonstrate exceptional leadership and stakeholder management skills, and a deep understanding of the delivery process and a service-oriented business preferably with US Healthcare client experience.A strategic orientation is critical as well as a proven ability to provide strong operational leadership and mentoring as well. The leader must bring strong stakeholder management skills in a matrix organization (internally to our Elevance stakeholders as well as externally to our commercial clients).Team Scope5 direct reports600-650 total FTE’sPosition Responsibilities
Responsible for the integration and management of the overpayment recovery lifecycle, including concept identification and validation, provider solicitation, claims adjustments, collections, and inquiry & disputes.
Provides leadership, management, and vision necessary to maximize accurate overpayment recovery while driving prevention efforts and Cost of Care savings.
Ensures the achievement of financial objectives and operational excellence.
Provides strategic leadership for both prepay and postpay programs to grow overpayment identification coverage, drive recovery results, and manage administrative costs.
Determines strategy for outsourcing, technology enablement and process efficiencies to effectively meet goals and minimize administrative expense.
Develops and executes a medical liability program to drive accurate claim payment.
Supports regulatory reporting and audit process.
Hires, trains, coaches, counsels and evaluates performance of reporting team.
Organizes, problem solves, raises issues and integrates initiatives, solutions and actions. Acts as an executive liaison to resolve problems and ensure successful implementation of company initiatives.
Drives the business to realize its long-term goals by translating strategies into actionable and quantitative plans, effective strategy cascades, and driving execution through ongoing performance management.
Develops and maintains relationships with key stakeholders, including clients, vendors, and internal stakeholders.
Participates in the BUs business meetings to discuss key metrics for the BU, Wins and Losses and learnings, short-term and long-term focus areas.
Participates in periodic leadership and monthly business review meetings to provide input into Carelon’s global strategy.
Builds a team and infrastructure to stay current with industry best practices and benchmarks against competitors and peers, maintaining a repository of best practices and process documents for the payment integrity function.
Position RequirementsA bachelor's or master's degree in a relevant field (e.g., Financial administration, business administration, consulting, global delivery, operations, engineering, computer science).At least 15 years of large-scale experience project management strategic planning and/or consulting, including minimum of 10 years people management experience; or any combination of education and experience, which would provide an equivalent background.Strong understanding of payment integrity and the overpayment recovery lifecycle and demonstrated experience in developing and implementing payment integrity frameworks.Proven track record leading a business unit, including liaising with global leadership and operating teams globally to develop and implement a strategic business management plan.Preferred Skills, Capabilities and Experiences
Strong Payment Integrity experience.
Ethical and hardworking, decisive, and results orientated.
Strategic and Growth Mindset: Polished and proven strategy skills in building consensus and alignment with executive stakeholders.
Servant leader: leader who models the way and has a history of building high performing teams.
The ability to build solid working relationships and influence (internally and externally)
Energy, proactivity, and desire to see things done efficiently.
Excellent communication, interpersonal, and leadership skills, with the ability to work effectively with a diverse range of stakeholders in a globally matrixed environment.
Strong analytical and problem-solving skills, with the ability to identify and address complex issues and challenges.
Proven ability to build and maintain strong relationships with clients, vendors, and internal stakeholders.
Demonstrated track record of driving continuous improvement and delivering results.
Strong strategic thinking with ability to translate strategy into operational goals, excellent collaboration, financial, analytical, and change management skills strongly preferred.
For candidates working in person or remotely in the below locations, the salary range for this specific position is $173,840 to $312,912Locations: California; Colorado; Nevada; New York; Washington State; Jersey City, NJIn 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 offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws .
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. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
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 AreElevance 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 WorkAt 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. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.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. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.EEO is the LawEqual Opportunity Employer / Disability / VeteranPlease use the links below to review statements of protection from discrimination under Federal law for job applicants and employees.
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