ElPasoRecruiter Since 2001
the smart solution for El Paso jobs

Staff VP Program Integrity Provider Audit (Reimbursement Strategy)

Company: Anthem, Inc
Location: El Paso
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, El Paso , Staff VP Program Integrity Provider Audit (Reimbursement Strategy), Accounting, Auditing , El Paso, Texas

Click here to apply!

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

I'm looking for
in category
within


Other Accounting, Auditing Jobs


Data Entry
Description: Our organization is Developing quickly and we are searching for Those who are inspired and energetic self starters to join our enterprise. You are going to be a huge part to our achievement as our Customer (more...)
Company: Cormadata
Location: El Paso
Posted on: 04/8/2020

Accounting Specialist
Description: Company Description br br Comet Signs was founded in 1958 in San Antonio, Texas. The company quickly established a strong reputation for quality products, on time performance and personal service (more...)
Company: Comet Signs
Location: El Paso
Posted on: 03/29/2020

Business (Finance, Accounting, Economics) Tutor (more than $1k+/mo)
Description: Varsity Tutors is looking to contract with tutors to connect with clients across a variety of academic subjects and major test prep through Varsity
Company: Varsity Tutors
Location: El Paso
Posted on: 03/29/2020


Audit Manager - Bank
Description: Purpose of JobWe are seeking a talented Audit Manager Bank for our San Antonio, TX, Plano, TX, or Remote facilities.Purpose of the JobLeads and executes both moderately and highly complex audit engagements (more...)
Company: USAA
Location: El Paso
Posted on: 03/27/2020

Assistant Controller
Description: DescriptionAchievement-oriented Assistant Controllers looking to work with a well-respected company, should apply through Robert Half Finance Accounting. The Assistant Controller reports to the Controller (more...)
Company: Robert Half Finance & Accounting
Location: El Paso
Posted on: 03/27/2020

Cost Accountant
Description: Company Description br br AYR Global IT Solutions is a national staffing firm focused on cloud, br cyber security, web application services, ERP, and BI implementations by br providing proven (more...)
Company: AYR Global IT Solutions Inc
Location: El Paso
Posted on: 03/29/2020

Credentialed Tax Expert - CPA, Enrolled Agent or Practicing Attorney - Seasonal Remote
Description: Say Hello to Working on the Bright Side We are Jovia
Company: Jovia Financial Credit Union
Location: El Paso
Posted on: 04/9/2020

Corporate Credit and Collections Professional
Description: Company Description br br Large, National San Antonio based Company is adding to their team. Company is very people centric with pride in the development of the team as well as in internal promotions. (more...)
Company: Z&A Recruiting
Location: El Paso
Posted on: 03/27/2020

Cash Apps Specialist
Description: IND 002-003 br br zr3 br br LI-LM2 br br Cash Applications Specialist br br Addison Group is seeking a Cash Applications Specialist for our client located in San Antonio, Texas.
Company: Addison Group
Location: El Paso
Posted on: 03/27/2020

2021 Fall Tax Associate
Description: LEAD TAX ASSOCIATE br br Position Description br br At RSM, associates work with large and small companies in various industries. They develop strong working relationships with clients built on (more...)
Company: RSM US
Location: El Paso
Posted on: 03/28/2020

Log In or Create An Account

Get the latest Texas jobs by following @recnetTX on Twitter!

El Paso RSS job feeds