Note: The job is a remote job and is open to candidates in USA. Sagility provides technology-enabled business process management and healthcare services focused on improving member and patient experiences, including payment integrity and analytics. The Director Payment Integrity Analytics will develop data reporting, data integrity practices, and analytic data architecture while leading end-to-end payment integrity implementation programs and supporting timely client onboarding, reporting, quality assurance, and project management.
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
- 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 escalate 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
Skills
- 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
- A 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
- 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
- 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)
Benefits
- Work@Home USA
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