Job Description

About the role
Title:
Quality Director (Payment Integrity)
Location:
Remote, United States
Department:
Payment Policy Management
Job Description:
Category: Payment Policy Management
Position type: full time
The Chief Quality Officer is responsible for ensuring quality delivery of the Payment Integrity Solution and driving excellence across multiple payment integrity products. This role will develop and implement a quality measurement framework, align quality processes across products, and establish monitoring mechanisms to communicate performance to senior management. The Director is focused on continuous improvement, providing greater quality in support of Cotiviti's growth strategy. Success in this role requires strong foundations in testing, technology, process management, operational acumen and collaboration. The Director will collaborate with clients and internal teams to ensure high-quality service delivery, consistently achieve and exceed service level benchmarks, and effectively manage processes through frequent changes to meet SLA requirements.
Responsibilities
Monitor and drive quality performance across all payment integrity solutions, ensuring continuous improvement and operational excellence.
Collaborate with cross-functional business units to measure, report and improve quality performance metrics and results.
Develop and align the best processes and quality standards, delivering exceptional results through operational excellence.
Work closely with Operations and Product teams to drive quality improvements by leveraging technology, optimizing processes, and developing talent.
Ensure timely and accurate responses to Requests for Payment Information (RFI) and Requests for Proposals (RFP).
Support customer intake requests for the PrePayment Business Unit by understanding customer requirements and providing customized solutions and cost estimates.
Hire, develop, train and retain top talent, fostering a culture dedicated to exceptional quality and customer satisfaction.
Optimize operational and labor expenses while increasing productivity, service quality, and supporting future customer growth.
Lead and support operational improvement initiatives that encompass people, processes and technology to deliver incremental value and operational efficiency, consistently meeting or exceeding service and quality objectives.
Enforce Cotiviti's intellectual property protection best practices in all operations.
Proactively diagnose and resolve issues, manage schedules, and ensure deadlines are met to complete work on time.
Develop short- and long-term plans to anticipate customer needs and operational improvements.
Cultivate a positive work culture that supports corporate objectives, promotes initiative, and encourages open communication at all organizational levels.
Collaborate and support business leaders across the organization, maintaining highly effective customer and team dynamics in a collaborative environment.
Manage and delegate individual and team projects/assignments, and review performance against operational plans and standards.
Provide comprehensive reporting and metrics to drive operational quality and inform strategic decisions, based on operational objectives and work plans at a higher level.
Build, maintain and influence strong relationships with executive leadership to support organizational objectives.
Hire, develop, train, lead and retain top-notch talent, with a focus on building and enhancing a team and culture that can help employ best-in-class practices to support and drive high levels of internal and external customer satisfaction.
Complete all responsibilities as outlined in the annual performance review and/or goal setting.
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Complete all special projects and other assigned tasks.
Must be able to perform duties with or without reasonable accommodations.
This job description is intended to describe the general nature and level of work performed and should not be construed as an exhaustive list of responsibilities, duties and required skills. This job description does not constitute an employment agreement and is subject to change as Cotiviti's needs and job requirements change.
Ratings
Bachelor's degree in business, operations, healthcare or equivalent in a related field required and master's degree preferred
Minimum five years of management experience, ideally in the healthcare industry.
Demonstrated operational excellence, exceptional problem-solving ability, and proven people leadership skills.
Experience collaborating with key stakeholders and executive decision makers.
Established leadership in directing operational divisions, shaping policies, practices and achieving division objectives.
Highly developed interpersonal, analytical and communication skills.
Proven track record of driving business improvement initiatives and delivering measurable results.
Deep process-oriented experience, with a focus on simplifying and scaling operations while maintaining superior quality.
Advanced technological competency, including experience in software development and payment integrity solutions.
Significant experience presenting to clients and senior managers.
Ability to respond to client requests for information, audits and proposals.
Exceptional performance management skills demonstrated through excellent organizational and team results.
Ability to excel in diverse, highly responsible, fast-paced environments while maintaining a strong focus on customer and customer service.
Extensive experience in strategic planning and operational development.
Recognized leadership qualities along with a history of successfully managing and developing high-performing teams.
Superior analysis and problem-solving capabilities, with a talent for diagnosing and resolving operational inefficiencies.
Excellent verbal and written communication skills, including public speaking experience.
Proficient in the Microsoft Office package (Word, Excel, PowerPoint).
Professional integrity, with experience in the proper handling of confidential information.
Able to work independently or collaboratively, effectively manage multiple priorities, and meet deadlines.
Experience operating in matrix organizational structures.
Demonstrated ability to effectively manage stressful situations, including high volumes and frequent changes.
Willingness to travel as business needs require.
Demonstrates flexibility and willingness to actively participate in the operations of an international organization, including attending conference calls scheduled to accommodate global time zones.
Solid foundation in quality assurance and testing methodologies.
Experience in design and implementation of quality measurement frameworks.
Demonstrated ability to align and standardize quality processes across a product portfolio.
Experience establishing and maintaining mechanisms for performance monitoring and reporting to senior management.
A proven track record in continuous improvement and elevation of organizational quality results.
Experience interacting with clients and internal teams to ensure consistent delivery of high quality service.
Track record of persistently achieving and exceeding service level agreements (SLAs) and benchmarks.
Effective change management skills and adaptability amidst frequent operational changes.
Experience in people leadership, with a focus on supporting organizational growth strategies.
Experience in process improvement within payment integrity or comparable environments.
Value-added certifications:
Lean Six Sigma (Green Belt, Black Belt or Master Black Belt): indicative of experience in process improvement and quality management.
Certified Quality Auditor (CQA) or Certified Manager of Quality/Organizational Excellence (CMQ/OE): Demonstrates recognized competency in quality assurance and organizational excellence.
Project Management Professional (PMP): Reflects strong experience in project and change management.
Certified Professional in Healthcare Quality (CPHQ) – Highly relevant to leadership in healthcare quality management, especially within payment integrity.
Certified Payments Professional (CPP) – Ideal for roles in payments integrity and financial services.
Base compensation ranges from $140,000 to $185,000 per year. Specific offerings are determined by several factors, such as experience, education, skills, certifications, and other business needs. This position is eligible to receive a discretionary bonus.
Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17 to 27 days of paid time off (PTO) per year, depending on the specific level and length of service with Cotiviti. For information about our benefits package, please see our Careers page.
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