ThousandOaksRecruiter Since 2001
the smart solution for Thousand Oaks jobs

Staff VP Program Integrity Provider Audit (Reimbursement Strategy)

Company: Anthem, Inc
Location: Thousand Oaks
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 An Equal Opportunity Employer/Disability/Veteran

Keywords: Anthem, Inc, Thousand Oaks , Staff VP Program Integrity Provider Audit (Reimbursement Strategy), Executive , Thousand Oaks, California

Click here to apply!

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

I'm looking for
in category

Other Executive Jobs

Director Social & Digital Marketing
Description: Dynamic and exciting opportunity for a Director of Social Digital Marketing to help lead our social and digital marketing team to develop and execute a multi-platform social strategy focused on growing (more...)
Company: REVOLT Media & TV
Location: Los Angeles
Posted on: 04/4/2020

Director, Marketing Operations
Description: The Director - Marketing Operations will lead key initiatives and programs across the marketing team to drive process improvement and service delivery. In this highly cross-functional role, your goal (more...)
Company: IMAX Corporation
Location: Los Angeles
Posted on: 04/4/2020

Group Marketing Director
Description: The Group Marketing Director for the Tenet Strategic Marketing Group TSMG will play an important role in Tenet------s continued transformation into a consumer-focused organization. This position will (more...)
Company: America's Health Insurance Plans (AHIP)
Location: Los Angeles
Posted on: 04/4/2020

Director of Quality & Food Safety
Description: Thrive Market is one of the fastest growing companies in Los Angeles and we're looking for an awesome Director of Quality Assurance/Quality Control to support our rapidly growing portfolio of products (more...)
Company: Thrive Market
Location: Los Angeles
Posted on: 04/4/2020

Senior Cost Manager
Description: One of the world's leading cost and project management companies, has an opening for a Senior Cost Manager in Los Angeles, CA. br The Cost Manager assists and supports the project team on large or multiple (more...)
Company: Hire Resolve
Location: Los Angeles
Posted on: 04/4/2020

Regional Sales VP (Investor)
Description: Minimum Required Skills Health, Sales, VP Of Sales, SalesForce, Zoho, HubSpot, Healthcare, Hospital, ASC, Surgical If you are a Regional Sales VP Investor with experience, please read on Top Reasons (more...)
Company: CyberCoders
Location: Los Angeles
Posted on: 04/4/2020

Account Director
Description: Wunderman Thompson is seeking an Account Director to lead the day-to-day management of the account assignments and have ultimate responsibility for development and maintenance of strong client relationships. (more...)
Company: J. Walter Thompson Company
Location: Los Angeles
Posted on: 04/4/2020

Anti - Money Laundering (AML) & Regulatory Compliance Consulting Director
Description: Assist in managing financial strategy planning, development, execution and achievement of defined financial plan objectivesServe as a key market-facing member of our team by leading growth activities (more...)
Company: RSM
Location: Los Angeles
Posted on: 04/4/2020

Director, Global Security Operations Center
Description: FOX Security provides security services throughout FOX and around the world. The Global Security Operations Center GSOC gives FOX Security the ability to provide security and safety support to FOX personnel (more...)
Company: Fox
Location: Los Angeles
Posted on: 04/4/2020

Sr. Director, Operations - Medi-Cal
Description: At Blue Shield of California we are parents, leader, students, visionaries, heroes, and providers. Everyday we come together striving to fulfill our mission, to ensure all Californians have access to (more...)
Company: Blue Shield of CA
Location: Woodland Hills
Posted on: 04/4/2020

Log In or Create An Account

Get the latest California jobs by following @recnetCA on Twitter!

Thousand Oaks RSS job feeds