Director of Payment Integrity Consulting

Director of Payment Integrity Consulting Category: Finance Main location: United States, Georgia, Atlanta Alternate Location(s): United States, Tennessee, Knoxville United States, Texas, Dallas United States, North Carolina, Charlotte Position ID: J0925-1435 Employment Type: Full Time Position Description: Client Engagement & Relationship Management: u2022 Serve as the primary point of contact and trusted advisor for high-profile clients, understanding their unique challenges and objectives. u2022 Develop and nurture strong, long-term relationships with key client stakeholders, including executive leadership, claims operations, finance, compliance, and clinical teams. u2022 Lead client discovery sessions, workshops, and presentations to diagnose issues, present solutions, and secure buy-in. Strategic Consulting & Solution Development: u2022 Conduct comprehensive assessments of client payment integrity programs, identifying areas for improvement, efficiency gains, and cost savings. u2022 Design and develop tailored payment integrity strategies, roadmaps, and solutions that align with client goals and industry best practices. u2022 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. u2022 Leverage advanced analytics, technology, and industry trends to propose innovative solutions and optimize processes. Project Leadership & Delivery: u2022 Lead and manage consulting engagements from inception to completion, ensuring projects are delivered on time, within budget, and to the highest quality standards. u2022 Oversee project teams, providing guidance, mentorship, and support to consultants and analysts. u2022 Develop detailed project plans, scope documents, and deliverables, ensuring clear objectives and measurable results. u2022 Monitor project progress, identify risks, and implement mitigation strategies. Thought Leadership & Business Development: u2022 Act as a thought leader in the payment integrity space, staying abreast of evolving industry trends, regulatory changes, and technological advancements. u2022 Contribute to the development of new service offerings, methodologies, and intellectual capital. u2022 Support business development by participating in proposal development, client presentations, and industry conferences. u2022 Represent the firm as a payment integrity expert in various forums. Team Development & Mentorship: u2022 Mentor and coach junior and mid-level consultants, fostering their professional growth and expertise in payment integrity. u2022 Contribute to the firm's knowledge sharing and continuous improvement initiatives. Your future duties and responsibilities: Client Engagement & Relationship Management: Serve as the primary point of contact and trusted advisor for high-profile clients, understanding their unique challenges and objectives related to payment integrity. 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 effectively 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 payment integrity 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 activities 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 (e.g., healthcare payer, large provider system, government agency, or reputable consulting firm) . 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 (e.g., CMS regulations, HIPAA) . Ability to travel as needed up to 50% . CPC, CCS, CFE certifications are a plus . Minimum Education Required: Bachelors 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. The determination of this range includes various factors not limited to skill set, level, experience, relevant training, and licensure and certifications. To support the ability to reward for merit-based performance, CGI typically does not hire individuals at or near the top of the range for their role. Compensation decisions are dependent on the facts and circumstances of each case. 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 Skills: + Health Care Payers + Leadership What you can expect from us: Together, as owners, letu2019s turn meaningful insights into action. Life at CGI is rooted in ownership, teamwork, respect and belonging. Here, youu2019ll reach your full potential becauseu2026 You are invited to be an owner from day 1 as we work together to bring our Dream to life. Thatu2019s why we call ourselves CGI Partners rather than employees. We benefit from our collective success and actively shape our companyu2019s strategy and direction. Your work creates value. Youu2019ll develop innovative solutions and build relationships with teammates and clients while accessing global capabilities to scale your ideas, embrace new opportunities, and benefit from expansive industry and technology expertise. Youu2019ll shape your career by joining a company built to grow and last. Youu2019ll be supported by leaders who care about your health and well-being and provide you with opportunities to deepen your skills and broaden your horizons. Come join our teamu2014one of the largest IT and business consulting services firms in the world. 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. If you need an accommodation to apply for a job in the U.S., please email the CGI U.S. Employment Compliance mailbox at . You will need to reference the Position ID of the position in which you are interested. Your message will be routed to the appropriate recruiter who will assist you. Please note, this email address is only to be used for those individuals who need an accommodation to apply for a job. Emails for any other reason or those that do not include a Position ID will not be returned. We make it easy to translate military experience and skills Clickhere (to be directed to our site that is dedicated to veterans and transitioning service members. All CGI offers of employment in the U.S. are contingent upon the ability to successfully complete a background investigation. Background investigation components can vary dependent upon specific assignment and/or level of US government security clearance held. Dependent upon role and/or federal government security clearance requirements, and in accordance with applicable laws, some background investigations may include a credit check. CGI will consider for employment qualified applicants with arrests and conviction records in accordance with all local regulations and ordinances. CGI will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with CGIu2019s legal duty to furnish information.

Created: 2025-10-04