Director of Payment Integrity Consulting
Position Description
Client Engagement & Relationship Management :
- Serve as the primary point of contact and trusted advisor for high-profile clients, understanding their unique challenges and objectives.
- 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 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 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 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 : Bachelor's Degree.CGI anticipates accepting applications through August 15.
Other Information :
CGI is required by law in some jurisdictions to include a reasonable estimate of the compensation range for this role. 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.Together, as owners, let’s turn meaningful insights into action.
Life at CGI is rooted in ownership, teamwork, respect and belonging.
Qualified applicants will receive consideration for employment without regard to their race, ethnicity, ancestry, color, sex, religion, creed, age, national origin, citizenship status, disability, pregnancy, medical condition, military and veteran status, marital status, sexual orientation or perceived sexual orientation, gender, gender identity, and gender expression, familial status or responsibilities, reproductive health decisions, political affiliation, genetic information, height, weight, or any other legally protected status or characteristics to the extent required by applicable federal, state, and / or local laws where we do business.
CGI provides reasonable accommodations to qualified individuals with disabilities.
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