Staff Vp Payment Integrity Operations

Description

A 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 Operations

Location

Within 50 miles, and commutable at least 3 days/week to an Elevance Health office

Summary

Responsible for the development and execution of Carelon’s Global Solutioning strategy, supporting existing and new business/technology stakeholders internally and externally, driving efforts to meet the company’s revenue and savings goals. Will organize and lead support efforts with new and existing clients, across all customer channels, while also ensuring direct alignment with the Carelon business plan, solution roadmap, and ongoing client engagement activities.

Team Scope

5 direct reports

600-650 total FTE’s

Position 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.

• Provides strategic vision and drives execution of strategy in support of multiple markets.

• 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 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. Travels to worksite and other locations as necessary.

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 $136,440 to $272,880.

Locations: California; Colorado; Hawaii; Nevada; New York; Washington State; Jersey City, NJ

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 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.

• (NOTE: Corporate position title is Staff VP Cost Optimization)

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. 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.comfor assistance.