Payment Integrity Specialist - Regulatory

About the Role

The Senior Business Process Consultant leads business case development for proposed initiatives, supports the strategic planning process, and leads larger scale, cross-functional initiatives.

Responsibilities

• Leads business case development for proposed initiatives to ensure adequate assessment of opportunities, risks, and return on investment.
• Provides input and supports planning and prioritization of initiatives as part of the strategic and business planning process.
• Ensures that initiatives support the strategic business plan, meet key business objectives, and are executed well tactically.
• Ensures that all approved business cases are transitioned to initiatives (both documentation and clear responsibilities for each initiative).
• Leads larger scale, cross-functional initiatives intended to drive performance improvement, financial gains, customer satisfaction, and improved compliance.
• Provides strategic and policy guidance on assigned initiatives to maximize effective implementation and results.
• Organizes work teams, drives consensus, and ensures end-to-end policy/process integrity to accomplish project work, including:
  • Identification and confirmation of participants
  • Establishment of a project plan
  • Consistent work team engagement and productivity
  • Meeting facilitation
  • Consensus building
  • Recommendation documentation and implementation oversight
• Performs detailed analysis of data, workflows, policies, procedures, organization of staff, and skills to execute initiatives.
• Supports project work by utilizing project management software such as Excel, PowerPoint, Visio, and Microsoft Project.
• Leads all levels of staff responsible for initiatives to support their success, development, and effective completion and communication of their initiative.
• Assists other project leaders in specific areas such as facilitation, analysis, process mapping, brainstorming, and project management issues.
• Writes and delivers communication to all levels of the organization to ensure support, awareness, and effectiveness of process improvement initiatives.
• Provides other related support as needed to improve business performance.
• Performs other duties as assigned.
• Complies with all policies and standards.

Requirements

• Bachelor's Degree in a related field or equivalent experience required.
• Master's Degree in a related field preferred.
• 6+ years managing projects required.
• Experience in health care and/or insurance preferred.
• Certified Project Management Professional (PMP) – PMI required.
• Process quality certification preferred.
• For Health Net and Enterprise Business Operations only: Certified Project Management Professional (PMP) – PMI preferred.

Pay

Pay Range: $87,700.00 - $157,800.00 per year. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives.

Benefits

• Competitive pay
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• Flexible approach to work with remote, hybrid, field, or office work schedules

Benefits may be subject to program eligibility.