Operations Manager, Payment Integrity

Job Description

It’s Time For A Change...

Your Future Evolves Here

Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving power that brings us to work each day. We believe in embracing new ideas, testing ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.

Are we growing? Absolutely. We have seen about 30% average growth over the last three years. Are we recognized? Definitely. We were named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016, 2017, 2018 and 2019 and are proud to be recognized as a leader in driving important Diversity and Inclusion (D&I) efforts: Evolent achieved a 95% score on its first-ever submission to the Human Rights Campaign's Corporate Equality Index ; was named on the Best Companies for Women to Advance List 2020 by Parity.org; and we publish an annual Diversity and Inclusion Annual Report to share our progress on how we’re building an equitable workplace. We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.

Payment Integrity Operations Manager

As a critical team member providing the 360-degree view of Payment Integrity operations to our HPS PI Leadership - by strongly interfacing with including but limited to internal Operations such as claims, audit, recovery, IT, Product Management, Tech Ops, Market Ops, Finance and Compliance. (S)he will build strong relationships within all internal stakeholders and have an exceptionally high service ethic. In addition, the Operations Manager is responsible for tracking follow-up items / resolution on key client issues, capturing status and meeting minutes, setting meeting agendas, along with other routine project management for PI operations. This individual manages performance against SLA’s and other key performance indicators and works closely with the Marker Ops team to manage client needs/ expectations.

This is role is meant to be a foundational starting point to develop and launch outstanding talent and future leadership into the HPS organization. Reporting to the Head of HPS Payment Integrity Services, the Manager has extraordinary opportunities to define the path of his/ her career along with this new offering from Evolent Health.

What You’ll Be Doing:

• Ensure Evolent Health is meeting or exceeding service level agreements (SLA’s) and other key operations performance indicators as part of the Payment Integrity services. Key performance indicators include but not limited to volume/ rate of incorrect payment identification, rate of recovery, cost of recovery, pre-pay vs. post-pay rates, etc.
• Report on and review operational and process tracking metrics and dashboards with the Director of Payment Integrity. Help proactively identify internal and external issues.
• Facilitate & participate in internal teamwork with Operations, Tech Operations, and/or IT to identify solutions to help drive issues to successful resolution.
• Developing client-facing content and communication (e.g., resolution plans, status updates, operations changes and next steps), as needed. This includes working with Market Ops team to prepare the monthly client-specific Operations Performance dashboard.
• Maintaining clear view on priority issues for any client, internal stakeholders/ teams and monitoring and managing issues to resolution.
• Learning internal operations and seeking out continuous improvement opportunities to enable our Payment Integrity services to grow and scale.
• Providing other support to the internal stakeholders, as needed
• Ensure strict compliance with federal and state regulations and company policies, procedures and processes.
• Perform other duties as assigned.

The Experience You Need (Required):

• AB or bachelor’s degree in business/ Healthcare/ Operations or related field
• Minimum of 2 years of experience in consulting, health care operations experience strongly preferred
• Demonstrated ability to get up to speed quickly
• Track record of ownership and tenaciously looking for ways to get results & improve the status quo
• Client service orientation
• Ability to manage multiple priorities while maintaining a positive attitude and sense of humor
• Detail orientation and project management skills combined with an ability to prioritize work
• Excellent computer, written, and communication skills

Technical requirements:

Currently, Evolent employees work remotely temporarily due to COVID-19. As such, we require that all employees have the following technical capability at their home: High speed internet over 10 MBPS and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled reopening of our office locations.

Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.