AtlantaRecruiter Since 2001
the smart solution for Atlanta jobs

Staff VP Program Integrity Provider Audit (Reimbursement Strategy)

Company: Anthem, Inc
Location: Atlanta
Posted on: March 28, 2020

Job Description:

Staff VP Program Integrity Provider Audit (Reimbursement Strategy) - PS34915Location: United StatesNewRequisition #: PS34915Post Date: 16 hours agoYour Talent. Our Vision. At Anthem, Inc., its a powerful combination, and the foundation upon which were creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.Preferred Office Locations:Norfolk or Virginia Beach, VAIndianapolis, INMason, OHAny Anthem office locationThe Staff VP of Provider Audit is a leadership role responsible for managing the Provider Audit department within the Program Integrity division of Anthems Diversified Business Group (DBG). The successful candidate will have extensive business transformation and organizational change experience, as well as people management skills to be equipped to work with the Vice President of Program Integrity along with peer Staff Vice Presidents and associates to advance the following business objectives:

  • Provide leadership and oversight to deliver a 200%+ improvement in cost of care savings within 12-18 months, while improving the operating structure: 1. Implement programs to elevate productivity and standardize audits 2. Identify and evaluate new and existing concepts and opportunities to deliver cost of care savings 3. Create a performance-based culture of delivery excellence, financial transparency and team accountability 4. Hiring the right mix of talent to scale the Provider Audit team to meet growing demand and potential commercialization effort, such as building out a BPO service.
  • Cultivate and manage demand from Anthem health plans, national accounts, and other clients to deliver value through services: 1.Develop an understanding of health plan and national account needs to craft relevant Provider Audit services 2. Work with Product & Efficiency to ensure emerging needs are addressed with Information Technology solutions and Business Services 3. Support commercialization initiatives to bring Provider Audit solutions to market overtime to serve both Anthem and other clientsParticipates in developing strategic direction for clinical reimbursement programs to foster elimination of fraud, waste, and abuse. Defines audit concepts to meet grow incremental cost of care value by 20-30% each year. Oversees program design and workflow to operationalize and enhance management of overpayments to increase program savings.Key Responsibilities
  • Manage the Provider Audit department to ensure financial and operational performance goals are achieved.
  • Influence clinical policies to support program implementation and adoption. Drive strategic direction of the Program Integrity Medical Director team and ensure strong partnerships with medical management.
  • Create a supportive culture that embraces new technologies and continuous process improvement.
  • Elevate performance for existing concept execution through standardization of business practices.
  • Streamline new concept creation to support effective expansion of Provider Audit to address emerging health plan needs.
  • Create and implement business plans to support scaling the departmentRequired:
    • BA/BS degree.
    • 10+ years related experience in broad based analytical, managed care payer or provider environment; demonstrated clinical thought-leadership experience including auditing experience.
    • Excellent leadership, financial and operational skills required.
    • Travel up to 15% - 20%.Preferred:
      • Ten years of management experience with strong organizational change management background and provider audit experience or clinical documentation improvement experience.
      • Any combination of education and experience which would provide an equivalent background.
      • MBA preferred. M.D. or D.O.
      • Board certification approved by the American Board of Medical Specialties a plus.Desired Experience/Skills:
        • Experience managing Provider Audit or Clinical Documentation Improvement (CDI) departments.
        • Demonstrated ability to identify new programs and influence clinical policy to enable program success.
        • Decisive, quick on your feet, strong executive presence with the ability to drive operational performance and new program launches.
        • Demonstrated capacity and track record of acting with a sense of urgency to tactically evaluate, implement programs and initiatives and work with a variety of organizational leaders to build consensus.
        • Sound analytical thinking, financial planning acumen, prioritization, and process orientation and execution skills.
        • Collaborative mindset to work with cross-functional teams to develop solution-oriented products and partnerships.
        • Strong communication skills, with ability to develop compelling written communications, term sheets and presentations.
        • Proven experience managing multiple, competing priorities while flawlessly executing on driving deliverables and operational tasks.
        • Project management and lean six sigma experience preferred, but not required.Anthem, Inc. is ranked as one of Americas Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com An Equal Opportunity Employer/Disability/Veteran

Keywords: Anthem, Inc, Atlanta , Staff VP Program Integrity Provider Audit (Reimbursement Strategy), Executive , Atlanta, Georgia

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Executive Jobs


VP, Operational Risk Officer
Description: Work cross-functionally with the Citi Retail Services Cards business, and support functions i.e. Operations Technology to analyze various risk factors, and solicit SME input for the purposes of identifying (more...)
Company: Citigroup
Location: Atlanta
Posted on: 04/1/2020

Senior Delivery Project Manager
Description: Your Story When you are seeking your next game-changing opportunity, what are you looking for ideally Chances are you are looking to be on a team that was founded by technologists for technologists and (more...)
Company: iVision
Location: Atlanta
Posted on: 04/1/2020

Vice President, Small Business Card Relationships (East Region)
Description: We are committed to helping customers leverage our tools to lower the stress of financial management and increase the profitability of the bottom line. We aspire to become a trusted advisor, an informed (more...)
Company: Capital One
Location: Atlanta
Posted on: 04/1/2020


CL Internal Account Manager
Description: General Description: Responsible for managing day to day client service activities including, but not limited to, processing policies, endorsements, audits, cancellations, database entry and preparation (more...)
Company: USI Insurance Services
Location: Atlanta
Posted on: 04/1/2020

Agile Project Manager - Application Development
Description: The IT Project Manager must have deep knowledge and expertise in software engineering processes and best practices and the judgement and practical experience to lead high-performing engineering teams (more...)
Company: AptoNet Inc
Location: Atlanta
Posted on: 04/1/2020

Director, Process Improvement
Description: Position Summary: br br This role is responsible for developing, implementing and maintaining a sustainable business process improvement methodology that ultimately drives measurable cost savings, (more...)
Company: Trellis Rx
Location: Atlanta
Posted on: 04/1/2020

Marketing Campaign Manager
Description: Overview br br MacStadium is the leading managed Mac hosting solution in the world and is headquartered in Atlanta, GA. We offer the only enterprise-class hosting solution for Apple Mac computers, (more...)
Company: Macstadium
Location: Atlanta
Posted on: 04/1/2020

Digital Senior Manager
Description: Meetings Events Digital Senior Manager 10426BR Business Management Operations WHAT YOU'LL DOBCG is in a period of rapid growth and transformation. Due to our continued growth, we are building our Meetings (more...)
Company: The Boston Consulting Group
Location: Atlanta
Posted on: 04/1/2020

GIS Consultant/Project Manager
Description: Avineon, Inc. is looking to add a GIS Consultant/Project Manager to our team of IT professionals. The candidate should have a minimum of five years of consulting and project management experience for (more...)
Company: Avineon
Location: Atlanta
Posted on: 04/1/2020

Esri Data Manager
Description: This is Hari Recruitment Lead from Product Modelling Corp PMC . We are in business since 1985, PMC has been a leading provider of digital manufacturing, engineering, supply chain, and operations productivity (more...)
Company: PMC
Location: Atlanta
Posted on: 04/1/2020

Log In or Create An Account

Get the latest Georgia jobs by following @recnetGA on Twitter!

Atlanta RSS job feeds