Lead Director, Business Consulting/Payment Integrity

Primary Responsibilities

• Lead strategic initiatives across Payment Integrity data mining and editing team
• Develop and manage multi-year strategic roadmaps supporting internal editing expansion and vendor optimization.
• Drive implementation of enterprise editing platforms including Lyric, internal editing solutions, and future technologies.
• Lead cross-functional teams responsible for business requirements, implementation planning, operational readiness, and deployment.
• Partner with technology, analytics, clinical, service operations, compliance, and vendor organizations to successfully deliver complex programs.
• Measure initiative performance through defined KPI's including implementation timelines, quality, financial impact, operational performance, and savings realization.

Required Qualifications

• 8+ years of progressive leadership experience in healthcare operations, Payment Integrity, claims editing, healthcare analytics, consulting, or strategic program management.
• Demonstrated experience leading large enterprise transformation initiatives across multiple business and technology organizations.
• Experience managing complex cross functional programs involving business operations, IT, clinical teams, analytics and external vendors.
• Strong knowledge of healthcare claims processing, payment integrity, claims editing, pre-pay and post-pay programs or healthcare reimbursement.
• Experience developing executive-level presentations, business cases, roadmaps, and strategic recommendations.
• Experience with measuring ROI, operational performance, and business outcomes.
• Experience leading managers and high-performing team.
• Ability to lead large-scale implementation and change management.

Preferred Qualifications

• Experience with Payment Integrity editing platforms such as Lyric, Cotiviti, PPM or similar claims editing solutions.
• Knowledge of SQL, healthcare data analytics, provider billing practices, or payment policy.
• Experience building governance framework, operational metrics and measurements.
• Demonstrated success leading enterprise modernization initiatives.

Education

Bachelor's degree in business Administration, Healthcare Administration, Information Systems, Healthcare management, or a related field required. Master's degree (MBA,MHA, MPH or related discipline) equivalent combination of education and relevant leadership experience will be considered.

Pay Range

The Typical Pay Range For This Role Is $100,000.00 - $231,540.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program.