A proud member of the Elevance Health family of companies, Carelon Global Solutions, formerly Legato Health Technologies, is a managed service delivery organization, providing information technology and business operations services for health plans.Staff VP Payments Integrity OperationsLocationWithin 50 miles, and commutable at least 3 days/week to an Elevance Health officeSummaryResponsible for the development and execution of Carelon’s Global Solutioning strategy, supporting existing and new business/technology stakeholders internally and externally, driving efforts to meet the company’s revenue and savings goals. Will organize and lead support efforts with new and existing clients, across all customer channels, while also ensuring direct alignment with the Carelon business plan, solution roadmap, and ongoing client engagement activities.Team Scope5 direct reports600-650 total FTE’sPosition Responsibilities
Responsible for the integration and management of the overpayment recovery lifecycle, including concept identification and validation, provider solicitation, claims adjustments, collections, and inquiry & disputes.
Provides leadership, management, and vision necessary to maximize accurate overpayment recovery while driving prevention efforts and Cost of Care savings.
Provides strategic vision and drives execution of strategy in support of multiple markets.
Ensures the achievement of financial objectives and operational excellence.
Provides strategic leadership for both prepay and postpay programs to grow overpayment identification coverage, drive recovery results, and manage administrative costs.
Determines strategy for outsourcing, technology enablement and process efficiencies to effectively meet goals and minimize administrative expense.
Develops and executes a medical liability program to drive accurate claim payment.
Supports regulatory reporting and audit process.
Hires, trains, coaches, counsels and evaluates performance of direct reports.
Position RequirementsRequires a BA/BS and minimum of 10 years' experience in operational leadership and healthcare; or any combination of education and experience, which would provide an equivalent background. Travels to worksite and other locations as necessary.Preferred Skills, Capabilities and Experiences
Strong Payment Integrity experience.
Ethical and hardworking, decisive, and results orientated.
Strategic and Growth Mindset: Polished and proven strategy skills in building consensus and alignment with executive stakeholders.
Servant leader: leader who models the way and has a history of building high performing teams.
The ability to build solid working relationships and influence (internally and externally)
Energy, proactivity, and desire to see things done efficiently.
Excellent communication, interpersonal, and leadership skills, with the ability to work effectively with a diverse range of stakeholders in a globally matrixed environment.
Strong analytical and problem-solving skills, with the ability to identify and address complex issues and challenges.
Proven ability to build and maintain strong relationships with clients, vendors, and internal stakeholders.
Demonstrated track record of driving continuous improvement and delivering results.
Strong strategic thinking with ability to translate strategy into operational goals, excellent collaboration, financial, analytical, and change management skills strongly preferred.
For candidates working in person or remotely in the below locations, the salary range for this specific position is $136,440 to $272,880.Locations: California; Colorado; Hawaii; Nevada; New York; Washington State; Jersey City, NJIn addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws .
The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
(NOTE: Corporate position title is Staff VP Cost Optimization)
Full-time