Job description
Position Summary
We are seeking an experienced Delivery Manager/Director to oversee the successful execution of Payment Integrity (PI) initiatives. This role will provide leadership across cross-functional teams, ensuring the timely delivery of solutions in areas such as DRG review, Hospital Bill Audit (HBA), Coordination of Benefits (COB), Independent Bill Review (IBR), Data Mining, and Edit Engine development.
Working closely with Business Analysts, Product Managers, and Operations leaders, the Delivery Manager/Director will manage project execution, resource allocation, risk mitigation, and stakeholder communication to ensure PI products and services are delivered on time, within scope, and with measurable value.
Responsibilities:
- Lead the planning, execution, and delivery of PI projects and operational initiatives.
- Partner with Business Analysts to translate documented requirements (BRDs, FRDs, user stories) into actionable delivery plans.
- Coordinate across operations, IT, QA, and data teams to ensure alignment and accountability.
- Establish and track key performance metrics (savings, accuracy, timeliness, client satisfaction).
- Manage project timelines, resource assignments, budgets, and risks, escalating issues proactively.
- Facilitate stakeholder communication through status reports, governance meetings, and executive updates.
- Drive continuous improvement in delivery processes, ensuring best practices in project management and PI operations.
- Ensure compliance with regulatory, contractual, and policy requirements impacting PI initiatives.
Qualifications
- Education: Bachelor’s degree in Business, Healthcare Administration, or related field. Master’s degree a plus.
- Experience:
- 3-5+ years in project/delivery management within healthcare, payer operations, or PI.
- Demonstrated success leading cross-functional teams delivering complex operational/technology solutions.
- Strong understanding of healthcare claims workflows and PI domains (DRG, HBA, COB, IBR, data mining, edit engines).
- Skills:
- Expertise in project management methodologies (Agile, Waterfall, or hybrid).
- Excellent leadership, organizational, and stakeholder management skills.
- Proficiency with project tracking tools (Jira, MS Project, Confluence, Smartsheet, etc.).
- Strong problem-solving and decision-making skills under pressure.
Preferred Experience
- Prior experience leading large PI programs (multi-million-dollar savings/recoveries).
- Knowledge of regulatory frameworks (CMS guidelines, NCCI edits, LCD/NCD policies).
- Experience working with payer SIU/FWA operations, subrogation, or provider audits.
- PMP, PgMP, or SAFe certification (or equivalent) preferred.
