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Organization TypePublic Interest
Date Last Verified
Years of Experience
ProfileDirector-Program Integrity The candidate will be responsible for the integrity of firm's Health Plans programs. Will interpret and ensure policy and procedures that impact reimbursement are compliant with all regulatory bodies for all lines of business. Develops a strategic framework that monitors and audits the quality of all internal operational programs. Understands and proactively communicates rules and relevant changes to assure the integrity of health plans while aligning regulations with business initiatives. Reviews and interprets guidelines while managing the associated business impact. Manages a team as well as collaborates with various internal department leaders. Serves as a member of the management team. Drives change in a complex environment while embodying the health plans mission and leading through respect and humility.
Qualification and Experience
The candidate should have Bachelors degree in Political Science, Public Affairs, or any critical thinking field. Advanced degree (ex. JD) preferred. Must have 7-10 years of experience in a healthcare organization. Familiarity with operations of a health plan including, revenue cycle, financial, quality assurance, and human resources procedures and regulations in the healthcare environment. Healthcare regulatory compliance experience strongly preferred. In addition, experience and expertise with healthcare payers and HIPAA strongly desired.Requires experience simultaneously managing multiple complex projects involving multiple partners, interests, and goals. Strong blend of management skills and technical expertise demonstrated by effective communication, planning, and decision-making skills/knowledge is required. Must have excellent attention to detail, critical thinking skills, and analytics skills. Must have knowledge of applicable Federal, State, and Local regulatory agency guidelines and laws. Must be well versed in Medicare Advantage, Marketplace and other Commercial lines of business and their respective regulatory requirements. Requires a thorough understanding of budget constraints and implications.
Requisition Number 225848
Indiana University Health
1701 Senate Blvd
Indianapolis, IN 46202