AVP of Payment Integrity in Boston, MA at Beacon Health Options

Date Posted: 6/27/2018

Job Snapshot

Job Description


Build a robust payment integrity center with Beacon that ensures a fair and transparent system for providers and protects financial value for clients.


  1. Launch and manage Beacon's retrospective claims integrity and recoveries program and ensure collection of first-wave of recoveries by end of 2016 and ongoing throughout 2017
  2. Demonstrate recovery of 80% of targeted claims recoveries on a quarterly basis, beginning in 4Q16
  3. In partnership with SVP Network Strategy, ensure strategy and operational buy-in from internal stakeholders by November 2016
  4. Manage activities of external partners brought in to collaborate with Beacon recoveries
  5. By December 2016 create and validate Beacon's exception list of all claims exception edits to serve as a front-door screen for payment integrity programs
  6. By February 2017 build process flows for exception list to be updated and modified as claims and code sets change in Beacon markets
  7. Participate in the strategy and development of Beacon's Program Integrity capability build, with a plan to be developed by 1Q17 of the 2-3 year plan to get Beacon to new state

Job description

Beacon is seeking an experienced claims or claims-recoveries leader to build and lead a new capability (claims recoveries) and to be part of the strategic team that creates a broad payment integrity capability.

Reporting to the SVP, Network Strategy, this Corporate AVP role will have immediate responsibility for the P&L of Beacon's retrospective claims recoveries activities through at least July 2017. This role will be the first in a newly planned department to update and strengthen Beacon's payment integrity capability, and the AVP will have meaningful participation in the development and structure of that new department.

General competencies

  1. Flexibility/adaptability: adjusts quickly to changing priorities and conditions; copes effectively with complexity and change
  2. Efficiency: able to produce significant output with minimal wasted effort
  3. Honesty/Integrity: does not cut corners ethically; earns trust and maintains confidences; does what is right, not just what is politically expedient; speaks plainly and truthfully
  4. Proactivity: acts without being told what to do; brings new ideas to the company
  5. Analytic skills: able to structure and process qualitative or quantitative data and draw insightful conclusions from it; exhibits a probing mind and achieves penetrating insights
  6. Attention to detail: does not let important details slip through the cracks or derail a project
  7. Persistence: demonstrates tenacity and willingness to go the distance to get something done
  8. Follow-through on commitments: lives up to verbal and written agreements, regardless of personal cost
  9. Calm under pressure: maintains stable performance when under heavy pressure or stress


  • Bachelor’s degree required
  • Minimum of 7 years progressively management and program experience with claims, claims edits, claims programs, payment integrity edits and activities are all desired.
  • Experience in a leadership role in claims quality/auditing large healthcare entity strongly preferred
  • Current or previous experience with Beacon's claims transactions systems highly desired.
  • Ability to travel 30-40%, with periods of multi-day trips and weeks of no travel.


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Beacon Health Strategies, LLC., a Beacon Health Options company, is proud to be an Equal Opportunity Employer as well as a Drug Free Work Environment. EOE/M/F/Veterans/Disabled