Director US Healthcare(Payment Integrity-Under Payment Recovery

Director – US Healthcare Operations (Payment Integrity – Underpayment Recovery)
Role Summary
The Director – US healthcare operations for Payment Integrity (Underpayment Solutions) is a strategic client-facing leadership role who is responsible for driving the Client Satisfaction, delivery, growth, financial performance, optimization and continuous improvement across Payment Integrity, Underpayment recovery process.
This role serves as the primary point of contact for clients throughout both pre-implementation and post-implementation phases, ensuring strong stakeholder engagement, transparent communication, and measurable financial outcomes.
The Director partners closely with Operations, Technology, Analytics, and Client Success teams to identify automation opportunities, improve process efficiency, enhance revenue recovery outcomes, and support scalable growth.
This role is accountable for revenue projections, resource planning, solution design, client satisfaction, and continuous process improvement across multiple engagement and delivery models.
Eligibility Criteria
15+ years of experience in US Healthcare Operations, Revenue Cycle Management especially in Payment Integrity.
Minimum 5+ years of leadership experience managing large operations with multiple layers of management.
Strong expertise in Payment Integrity, Underpayment Recovery, Overpayment Identification and Recovery, Credit Balance Review (CBR), Reimbursement, Appeals, and Denial Management.
Strong understanding of HIPAA X12 EDI transactions, specifically:
837 Professional (P) & Institutional (i) Claims
835 Remittance Advice and Payment files
Experience analysing, interpreting, and validating EDI file structures, segments, loops, and elements and familiarity with EDI tools, XML/JSON transformations, data mapping, and ETL processes
Ability to document business requirements and translate EDI specifications into technical requirements and automation initiatives.
Experience working with developers, data engineers, and integration teams to design and implement data parsing and mapping solutions
Ability to troubleshoot file errors, identify data quality issues, and coordinate resolutions with technical teams.
Proven success in client relationship management, stakeholder engagement, and business growth.
Strong analytical, financial, and operational management skills.
Excellent communication, presentation, and negotiation skills.
Key Responsibilities
Client Leadership & Relationship Management
Serve as the primary client-facing leader for Payment Integrity Underpayment programs.
Establish and maintain strong relationships with client executives, operational leaders, and key stakeholders.
Lead client discussions during pre-sales, implementation, and ongoing account management activities.
Present program performance, revenue opportunities, and strategic recommendations to clients.
Act as a trusted advisor, ensuring alignment between client objectives and delivery outcomes.
Manage client escalations and drive effective resolution through cross-functional collaboration.
Pre-Implementation & Solution Design
Partner with clients to understand payment integrity objectives, and recovery opportunities.
Support solution development, implementation planning, and operational readiness assessments.
Define program scope, success metrics, and reporting requirements
Develop financial projections and expected revenue recovery estimates based on available data and historical performance.
Collaborate with internal stakeholders to ensure a seamless implementation process.
Post-Implementation Management
Monitor program performance against client commitments and financial targets.
Conduct regular business reviews and performance discussions with clients.
Identify opportunities to expand recovery programs, improve audit effectiveness, and increase revenue generation.
Ensure sustained client satisfaction and long-term partnership growth.
Drive continuous improvement initiatives based on operational insights and client feedback.
Technology & Innovation Partnership
Collaborate closely with Technology, Product, Data Science, and Analytics teams to identify automation opportunities.
Translate operational and client requirements into technology enhancements and product improvements.
Define critical data requirements, reporting frameworks, and analytical insights needed to optimize recovery performance.
Advocate for process digitization, workflow automation, and AI-enabled solutions to improve efficiency and scalability.
Participate in prioritization and validation of technology initiatives that enhance revenue recovery and operational excellence
Revenue Management & Financial Oversight
Develop and maintain revenue forecasts, recovery projections, and business growth plans.
Analyse performance trends and identify opportunities to maximize financial outcomes.
Monitor operational productivity, recovery yields, and client-specific financial metrics.
Provide leadership with accurate forecasting and business performance reporting.
Support business development initiatives through financial modelling and solution recommendations.
Strategic Leadership & Organizational Vision
Define and execute the strategic vision for the Payment Integrity and US Healthcare Operations business.
Align operational objectives with the organization's long-term goals, growth plans, and transformation initiatives.
Develop and implement scalable operating models that support business expansion and client success.
Drive innovation and foster a culture of continuous improvement, accountability, and operational excellence.
Serve as a strategic advisor to executive leadership on operational performance, industry trends, and growth opportunities.
Build a future-ready organization through workforce transformation, technology adoption, and capability development.
Cross-functional collaboration
Partner with Operations leadership to meet service level agreements and performance targets.
Leverage data analytics to identify trends, root causes, and opportunities for improvement
Collaborate with Sales, Operations, Technology, Analytics, and Finance teams to achieve business objectives.
Utilize predictive insights to proactively address business challenges and operational risks.
Serve as the executive point of contact for key client relationships and strategic partnerships.
Lead client governance meetings, Quarterly Business Reviews (QBRs), operational reviews, and executive-level discussions.
Ensure client satisfaction by consistently delivering on SLAs, KPIs, quality standards, and business objectives.
Collaborate with clients to identify opportunities for process improvements, cost savings, payment accuracy, and operational efficiencies.
Develop trusted relationships with senior client stakeholders and act as a strategic partner in achieving their business goals.
Support business development and client retention initiatives by presenting capabilities, solutions, and transformation roadmaps.
Ensure compliance with client requirements, industry regulations, and organizational policies.
Support contract renewals, business expansion opportunities, and strategic client engagements.
Payment Integrity Leadership
Oversee end-to-end Payment Integrity operations, including:
Underpayment Recovery
Overpayment Identification and Recovery
Credit Balance Review (CBR)
Reimbursement Analysis
Appeals Management
Denials Management
Claims Audit and Validation

Work arrangement
No