Staff VP Program Integrity Provider Audit (Reimbursement Strategy)
Company: Anthem, Inc
Posted on: March 28, 2020
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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
careers.antheminc.com An Equal Opportunity
Keywords: Anthem, Inc, Whittier , Staff VP Program Integrity Provider Audit (Reimbursement Strategy), Executive , Whittier, California
Didn't find what you're looking for? Search again!