Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights, formerly Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical-expense spending.
Staff VP Payment Integrity (Edits)
Location: Successful candidate must reside within 50 miles of an Elevance Health office location, and able to be in-office 3 days per week (hybrid)
Summary
Responsible for strategy development, execution, management, and compliance associated with prepay edits. Provides leadership, management, and vision necessary to maximize accurate edit execution while driving CoC, optimal edit performance, and emerging business growth opportunities.
Team Scope
6 - 7 direct reports; 55+ indirect reports
Position Responsibilities
Provides strategic vision, leads cross-functional engagement, and drives execution of edit strategy in support of multiple markets, products, and business opportunities.
Ensures achievement of financial objectives and operational excellence. Provides strategic leadership for prepay programs, vendor management, operational performance, and administrative cost management.
Determines strategy for technology enablement and process efficiencies to effectively meet goals and minimize administrative expense.
Supports regulatory performance, reporting and audit processes.
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.
Preferred Skills, Capabilities and Experiences
Background in Payment Integrity including understanding and knowledge of prepay edits preferred.
Corporate Title: Staff VP Cost Optimization
For candidates working in person or remotely in the below locations, the salary* range for this specific position is $158,960 to $286,128
Locations: California; Colorado; District of Columbia (Washington, DC), Hawaii; Jersey City, NJ; Maryland, Nevada; New York; Washington State
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.
