Director, Payment Integrity Program Development

United States

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Not SpecifiedCompensation

Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

Health Insurance, HealthcareIndustries

Requirements

Candidates must possess a Bachelor's degree and at least 10 years of relevant professional experience. A strong understanding of U.S. healthcare, claims adjudication, revenue cycle management, and payment integrity is required, along with a proven track record of using data to inform medical cost savings strategies. Exceptional leadership and execution skills are necessary, with the ability to drive complex projects and operate in both leadership and execution roles within a fast-paced environment. Proficiency with SQL or other data querying tools and people management experience are desired.

Responsibilities

The Director, Payment Integrity Program Development will lead critical payment integrity initiatives, ensuring cross-functional alignment and on-time delivery. They will partner with technology teams to implement tools for data analysis and workflow enhancement, and develop the strategic vision for new payment integrity programs aligned with organizational goals and Medicare Advantage regulatory requirements. This role involves generating innovative concepts to address claim payment leakage, fraud, waste, and abuse, monitoring Medicare Advantage policy changes, and fostering collaboration with cross-functional teams. Key performance indicators will be established and monitored to measure program success.

Skills

Payment Integrity

Healthcare

Claims Analysis

Program Development

Strategic Planning

Stakeholder Management

Data Analysis

Medicare Advantage

Devoted Health

Medicare Advantage plans with personalized support

About Devoted Health

Devoted Health provides Medicare Advantage plans aimed at simplifying and making healthcare more affordable for seniors aged 65 and older. Their plans include services like provider and pharmacy searches, prescription drug coverage, and preventive care rewards. Members pay premiums for these plans, and the company may also receive government payments for managing Medicare benefits. What sets Devoted Health apart from competitors is their high level of customer service, featuring Devoted Health Guides who assist members in navigating their healthcare options and addressing common issues with traditional insurance. Additionally, they promote preventive care through the Devoted Dollars program, which rewards members for engaging in health activities. The goal of Devoted Health is to create a more compassionate and accessible healthcare experience for its members.

Waltham, MassachusettsHeadquarters

2017Year Founded

$2,194.5MTotal Funding

SERIES_ECompany Stage

HealthcareIndustries

1,001-5,000Employees

Benefits

Comprehensive health plan

401(k) retirement plan

Generous vacation and holiday time

Lyra mental health resources

Time off to vote

Risks

Increased competition from Medicare Advantage providers like Clover Health and Oscar Health.

Potential regulatory changes affecting Medicare Advantage plans by CMS.

Rising healthcare costs could impact the affordability of Devoted Health's plans.

Differentiation

Devoted Health offers personalized assistance through Devoted Health Guides for member support.

The company emphasizes preventive care with its Devoted Dollars rewards program.

Devoted Health integrates virtual and in-home care with top local providers.

Upsides

Devoted Health raised $287 million in Series E funding in 2024.

The company expanded Medicare Advantage plans to eight new states in 2023.

Devoted Health achieved a 5-star Medicare Advantage rating in Ohio in 2023.

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