Healthcare Compliance - Payer Senior Manager

8 - 10 years experience  •  Financial Services

Salary depends on experience
Posted on 10/31/17
Minneapolis, MN
8 - 10 years experience
Financial Services
Salary depends on experience
Posted on 10/31/17

JR-206404

At Protiviti, we believe that a career is about more than just working, providing deliverables, and being compensated for your efforts. A Protiviti Career is about opportunities to lead, learn, grow, and make a difference.

We strive to recruit and hire the best talent. But it doesn't stop there. Once you join us, we build your career through exceptional work experiences, a culture focused on learning and development, and a commitment to the things that matter to you.

Are you inspired to make a difference?

You've come to the right place.

JOB REQUISITION

Healthcare Compliance-Payer Senior Manager (Minneapolis, Chicago, or New York)

LOCATION

NEW YORK CITY

ADDITIONAL LOCATION

MINNEAPOLIS

JOB DESCRIPTION

The following statements are intended to describe the general nature and level of work being performed. This is not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of team members.

The Senior Manager is responsible for:

  • Overseeing product solutions within the Healthcare practice
  • Leading project planning, administrative and project management activities on all assigned projects.
  • Maintaining client satisfaction on all assigned projects.
  • Leveraging technical competence in product solution or industry to articulate the value of our business to existing or prospective clients.
  • Developing a portfolio of business through exceptional client service delivery and active involvement in proposal opportunities.
  • Maintaining overall responsibility for the profitability of all client related work within their portfolio as well as managing the profitability of these portfolios. 
  • Having supervisory responsibility of and providing feedback to Consultants, Senior Consultants, and Managers, along with providing longer-term advising to a select number of team members.
  • Fostering the development of a positive teaming environment for all engagement team members.
  • Managing multiple client projects simultaneously, while also working on internal initiatives and proposal opportunities.
  • Formulating initiatives that contribute to the strategic aims of the healthcare service line and leading the execution of such initiatives.
  • Attending industry conferences to represent the firm, understand the marketplace, and network with perspective clients.
  • Taking an active role in identifying and recruiting the future employees of Protiviti.
  • Delivering on Protiviti’s strategic objectives, including Our Promises to Our People:
    • Creating exceptional development opportunities
    • Fostering a global, collaborative, workplace
    • Creating opportunities for our Seniors and Consultants to have an impact
    • Remain committed to the communities that we serve

EDUCATIONAL & PROFESSIONAL CREDENTIALS

  • Bachelor’s degree in relevant discipline required, with a degree in accounting or law preferred
  • 8+ years experience in the healthcare payer industry, including PBM and TPA organizations
  • Prior consulting experience a plus
  • Prior experience with a payer call center, appeals/grievances, claims, or utilization management
  • Clinical experience or training as an LPN, RN, or pharmacist/pharmacy technician a plus

REQUIRED KNOWLEDGE & SKILLS

  • Exceptional leadership, and team building skills
  • Excellent interpersonal skills to interact in team environment and foster client relationships.
  • Advanced verbal and written communication skills including documentation of data gathering interviews, familiarity with process controls documentation, audit or gap assessment findings and recommendations
  • Strong analytical and problem solving skills
  • Extraordinary attention to detail
  • Strong project management skills

REQUIRED TECHNICAL KNOWLEDGE & SKILLS

  • Deep CMS regulatory knowledge, including Medicare Advantage Chapter 21/9 experience
  • In-depth knowledge of Medicaid and Medicare Advantage operational processes, FDR’s and program audit and universe development.
  • Strong HIPAA knowledge
  • Strong knowledge of the commercial insurance industry products including ACA, fully and self- insured products and services.
  • Proficient in Microsoft Office suite applications with specific emphasis on Word, Excel, and PowerPoint.  Secondary emphasis on Visio and Access.

ABILITY TO TRAVEL

  • Travel throughout the month frequently required based upon client requests/commitments.  Travel may include suburban, regional, or out of state locations.

Protiviti is not licensed or registered as a public accounting firm and does not issue opinions on financial statements or offer attestation services.

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