Director of Payment Integrity Consulting

Director of Payment Integrity Consulting

Client Engagement & Relationship Management : Serve as the primary point of contact and trusted advisor for high-profile clients, understanding their unique challenges and objectives related to payment integrity. Develop and nurture strong, long-term relationships with key client stakeholders, including executive leadership, claims operations, finance, compliance, and clinical teams. Lead client discovery sessions, workshops, and presentations to effectively diagnose issues, present solutions, and secure buy-in.

Strategic Consulting & Solution Development : Conduct comprehensive assessments of client payment integrity programs, identifying areas for improvement, efficiency gains, and cost savings. Design and develop tailored payment integrity strategies, roadmaps, and solutions that align with client goals and industry best practices. Provide expert guidance on various payment integrity domains, including pre-payment review, post-payment audit, FWA detection and prevention, coding accuracy, clinical integrity, and provider data management. Leverage advanced analytics, technology, and industry trends to propose innovative solutions and optimize payment integrity processes.

Project Leadership & Delivery : Lead and manage consulting engagements from inception to completion, ensuring projects are delivered on time, within budget, and to the highest quality standards. Oversee project teams, providing guidance, mentorship, and support to consultants and analysts. Develop detailed project plans, scope documents, and deliverables, ensuring clear objectives and measurable results. Monitor project progress, identify risks, and implement mitigation strategies.

Thought Leadership & Business Development : Act as a thought leader in the payment integrity space, staying abreast of evolving industry trends, regulatory changes, and technological advancements. Contribute to the development of new service offerings, methodologies, and intellectual capital. Support business development activities by participating in proposal development, client presentations, and industry conferences. Represent the firm as a payment integrity expert in various forums.

Team Development & Mentorship : Mentor and coach junior and mid-level consultants, fostering their professional growth and expertise in payment integrity. Contribute to the firm's knowledge sharing and continuous improvement initiatives.

Required qualifications to be successful in this role :

• 10 years of progressive experience in payment integrity, with a significant portion in a consulting or advisory capacity
• 5 years of experience in leadership or management roles, leading projects and teams
• 5 years of experience in healthcare claims adjudication, medical coding, DRGs, and / or reimbursement methodologies
• 5 years of experience in identification and mitigation of fraud, waste, and abuse
• 5 years of experience with conducting complex data analysis, interpret findings, and translate them into actionable recommendations
• 5 years of experience understanding and translating relevant regulatory compliance
• Ability to travel as needed up to 50%
• CPC, CCS, CFE certifications are a plus
• Minimum Education Required : Bachelors Degree

CGI anticipates accepting applications through August 15. Compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range for this role in the U.S. is $143,000.00 - $305,800.00. CGI's benefits are offered to eligible professionals on their first day of employment to include : competitive compensation, comprehensive insurance options, matching contributions through the 401(k) plan and the share purchase plan, paid time off for vacation, holidays, and sick time, paid parental leave, learning opportunities and tuition assistance, wellness and well-being programs.

Skills : Health Care Payers, Leadership

What you can expect from us : Together, as owners, let's turn meaningful insights into action. Life at CGI is rooted in ownership, teamwork, respect and belonging. Here, you'll reach your full potential because You are invited to be an owner from day 1 as we work together to bring our Dream to life. That's why we call ourselves CGI Partners rather than employees. We benefit from our collective success and actively shape our company's strategy and direction. Your work creates value. You'll develop innovative solutions and build relationships with teammates and clients while accessing global capabilities to scale your ideas, embrace new opportunities, and benefit from expansive industry and technology expertise. You'll shape your career by joining a company built to grow and last. You'll be supported by leaders who care about your health and well-being and provide you with opportunities to deepen your skills and broaden your horizons. Come join our teamone of the largest IT and business consulting services firms in the world.