Senior Director Payment Integrity Operations

Overview

The Sr. Director of Payment Policy Management (PPM) Operations is responsible for overseeing the business operations within Cotiviti’s Payment business unit. This role plays a critical part in supporting sales, client engagement, business improvement, and operational processes. The Sr. Director will provide both strategic direction and team leadership, ensuring exceptional service for clients while positioning the organization for continued growth in alignment with business unit objectives.

The ideal candidate will possess strong operational acumen, business transformation and people management skills. S/he will be required to communicate with the client (externally) and various departments of Cotiviti (internally) to ensure high quality of service. Achieving and exceeding service level benchmarks is a key responsibility. Success in this role will depend on a thorough understanding of operational processes and the ability to manage them efficiently amidst frequent changes to meet established SLAs.

• Represent the business unit and operations by defining operational requirements that enable scalable, efficient, and high-quality delivery.
• Respond promptly to Payment Requests for Information and Requests for Proposals.
• Support client intake requests for the Pre Payment business unit by understanding client requirements and providing tailored solutions and cost estimates.
• Hire, develop, coach, lead, and retain top-tier talent, fostering a team and culture dedicated to implementing best-in-class practices that drive superior internal and external customer satisfaction.
• Optimize labor and operating expenses while increasing productivity, service quality, and supporting future client growth.
• Collaborate with key partners to ensure operational excellence.
• Sponsor, lead and support operational improvement initiatives related to people, processes, and technology to deliver incremental value, enhance operational efficiency, and meet or exceed service and quality goals.
• Develop lean business cases, establish key performance indicators, and create requirements and test plans for business improvement initiatives.
• Communicate business unit performance and improvement initiatives to relevant stakeholders.
• Enforce Cotiviti’s intellectual property protection best practices.
• Ensure clinical operations comply with regulatory, accreditation, corporate, and client requirements.
• Diagnose and resolve issues, prepare schedules, and set deadlines to ensure timely completion of work.
• Develop short-term and long-term plans to anticipate client needs and drive operational improvements.
• Foster a positive culture that supports corporate goals, encourages initiative, and promotes open communication across all levels of the organization.
• Work closely with and support business leaders throughout the organization.
• Establish and maintain effective client and team dynamics in a highly collaborative manner.
• Manage and delegate team and individual projects and assignments.
• Review performance against operating plans and standards.
• Provide reports and metrics to drive continuous operational quality.
• Cultivate and maintain personal relationships with executive leadership.
• Complete all responsibilities as outlined in the annual Performance Plan.
• Complete all special projects and other duties as assigned.
• Perform duties with or without reasonable accommodation.

This job description is intended to describe the general nature and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties, and skills required. This job description does not constitute an employment agreement and is subject to change as the needs of Cotiviti and the requirements of the job change.

• Bachelor’s degree in business, operations, healthcare or equivalent in a related field required and Master’s preferred.
• Relevant certifications such as Lean Six Sigma, PMP, or Certified Payments Professional (CPP) are highly regarded.
• A minimum of 10 years’ experience managing operations, consulting, or healthcare management, including decision rights for hiring and terminating employees, and management of operational…