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Payment Accuracy Data Mining Solution Lead Job in Grove City, Ohio US

Payment Accuracy Data Mining Solution Lead

Change Healthcare Solutions, LLC - Grove City, OH

Posted: 2/25/2020 - Expires: 5/25/2020

Job ID: 216199774

Job Description

Transforming the future of healthcare isn't something we take lightly. It takes teams of the best and the brightest, working together to make an impact.
As one of the largest healthcare technology companies in the U.S., we are a catalyst to accelerate the journey toward improved lives and healthier communities.Here at Change Healthcare, we're using our influence to drive positive changes across the industry, and we want motivated and passionate people like you to help us continue to bring new and innovative ideas to life.

If you're ready to embrace your passion and do what you love with a company that's committed to supporting your future, then you belong at Change Healthcare.
Pursue purpose. Champion innovation. Earn trust. Be agile. Include all.
Empower Your Future. Make a Difference.


The Payment Accuracy Data Mining Solution Leader will ensure that Change Healthcare delivers competitive solutions to our customers that maximizes and contributes to the business results and strategic plan of the organization. This role will lead the ideation, technical development and launch of innovative products.  This includes defining, building, launching and actively managing a portfolio of products and solutions that align with organizational strategies, enhance our brand and competitive position in the marketplace, and delight our customers.

The Payment Accuracy Data Mining Solution Leader will be responsible for the coordination of the cross-functional partnership composed of business leaders, sales, marketing, services, support, business analysts, development, internal support functions and external customers.

Position Profile:

The Data Mining suite of audit solutions utilizes contract, pricing, and policy applications without requiring a chart review. The Data Mining suite of audit solutions utilizes contract, pricing, and policy applications without requiring a chart review.  The Solution Leader delivers an adeptness in identifying errors and exceptions that result in valid claim error. Ability to analyze data, identify inconsistencies and formulate workable solutions. The Solution Leader must have an extensive background in claims reimbursement, strong knowledge of claims data fields and multiple client system experience including FACETS, NASCO and QNXTt. The leader should have a solid track record of innovation, leadership, delivery, and have a strong customer focus. The candidate must have a proven ability to coordinate across a matrixed environment. The candidate must have a strong historical perspective on both the evolution and future direction of Payment Accuracy related to their specific solution and the healthcare industry. The ideal candidate will be a thought leader, an innovator, self-motivated and a driver. Hyper focused on growth, this Leader will strategically plan and execute sound business actions resulting in superior YOY margin growth.

These tech savvy innovators leverage their keen business insight and strategic mindset to build customer-centric solutions that drive results.  They plan and prioritize work to ensure that commitments are honored as they build internal and external partnerships working collaboratively to meet shared objectives.

Solution Leaders are customer-obsessed and actively learn through agile experimentation, design thinking, and market sensing as they strive to design user/consumer centric solutions with a results/outcomes orientation. They are always seeking to tackle new problems and learn from both success and failure as they boldly invent and enhance new solutions to ensure Change Healthcare remains an industry leader.

Key Responsibilities:

Product & Solution Development: Drives product development with IT engineers and solution designers, concept developers and Auditor teams.  Working collaboratively to lead and manage 'end to end', the definition, development and/or delivery of a significant product, solution or service to ensure alignment with customer requirements ascertained through personal insight gained from focused customer engagement, empathy interviews and observations.
New Product Innovation: Works with business owners, UX team, and directly with customers to identify business opportunities and leads and manages efforts to bring new products to market balancing stakeholder needs and introducing innovative approaches, including focus on opportunities for Artificial Intelligence, Machine Learning and Robotic Process Automation.
Product Vision/Brand: Establishes a shared product, solution, or service vision across the enterprise by building consensus on priorities leading to product execution, and ensuring that the product, solution, or service is aligned with Change Healthcare's brand, strategic and competitive position, and other related/interfaced product, solution, or service.
Product Roadmap: Defines and analyzes metrics that inform the success of products, including the feature sets, business requirements, and measures of success of an overall roadmap, aligned with business strategy, and customer needs and informed by competitive intelligence, aligns with the market (buyers, end consumers, delivery partners) to lead and manage the design a product, solution, or service strategy that is market driven.
Budgeting & Costing: Leads and manages the development and/or delivery of budget plans to successfully achieve P&L goals, applying financial acumen to ensure decision quality.
Client & Customer Management Internal/External: Supports key client and customer relationships to ensure their ongoing satisfaction and loyalty toward the organization which requires simultaneously managing relationships with multiple key internal customers.  To include strong emphasis on new contract review and contract renewals.
Comprehensive Data Collection, Research & Analysis: Makes authoritative technical and/or professional recommendations that have a significant short-term and long-term impact on the business. Integrates usability studies, research, market analysis, solution validation, and design thinking into product, solution, and service requirements to enhance user satisfaction. Defines requirements based on intimate knowledge of the customer and technology, and with a keen eye on the competitive landscape, continuously scanning, learning and implementing insights into product design.
Project Management: Leads, manages, and delivers required outcomes for a portfolio of major projects in order to support the overall strategy.  Uses expertise to act as the organization's authority on managing projects and/or programs within desired cost, time and quality parameters.
Regulatory and Legal Compliance: Understands the applicable regulatory and legal requirements for product, solution, and service offerings; uses privacy, cybersecurity and other compliance by design concepts to insure product, solution or service offerings are compliant on launch and throughout end to end life cycle; leads and manages efforts to audit/attest to such compliance.
Verbal & Written Communication: acts with expertise as the organization's authority on using clear and effective verbal and written communications skills to express ideas, request action and formulate plans or policies.

Core Capabilities:

Manages Complexity: makes sense of complex, high quantity, and sometimes contradictory information to effectively solve problems.
Advances Innovation:  creates new and better ways for the organization to be successful.
Business Insight: applies knowledge of business and the marketplace to advance the organization's goals.
Financial Acumen: interprets and applies understanding of key financial indicators to make better business decisions.
Strategic Mindset: sees ahead to future possibilities and translates them into breakthrough strategies, implementing innovative solutions.
Organizational Savvy: maneuvers comfortably through complex policy, process, and people-related organizational dynamics to drive results.
Plans and Aligns: plans and prioritizes work to meet commitments aligned with organizational goals with attention to detail.
Decision Quality: makes good and timely decisions that keep the organization moving forward.
Collaborates: builds partnerships and works collaboratively with others to meet shared objectives.
Communicates Effectively: develops and delivers multi-modal communications that convey a clear understanding of the unique needs of different audiences.
Customer Focus: builds a robust understanding of external customer needs (user focused, jobs to be done) and strong customer relationships to deliver customer-centric solutions.
Culture: develop culture that supports growth of business and people; accountable for managing OKR process, talent development, encourages employee engagement

Technical Capabilities:

Commercial Acumen: acts as the organization's authority and established expert to develop solutions based on an understanding of the business environment, competitive landscape, and objectives.
Technology Skills: acts as the organization's authority and established expert on understanding and using technology (including software and related tools) to support innovation.
Planning & Organizing: uses expertise to act as organization's authority on planning, organizing, prioritizing and overseeing activities to efficiently meet business objectives, including meeting financial objectives, budgets, and forecasts.
Data Collection and Analysis: acts as the organization's authority and established expert on analyzing data trends for use in reports to help guide decision making.
Project Management: uses expertise to act as the organization's authority on managing projects and/or programs within desired cost, time and quality parameters.
Customer and Market Analysis: works collaboratively with Internal Partners to share and apply joint expertise to serve as the organization's authority on conducting research and analyzing data in order to develop a comprehensive understanding of customer and market conditions that enables maximum return on investments.

Education and Experience:

7 - 10 Years broad and deep Product Management/People Leadership experience
5+ years broad data mining and claim reimbursement concepts and strategy, including pre- and post-payment Strong knowledge of CMS guidelines
Experience in claim payment adjudication, medical payment policy, and/or utilization management; experience in CPT-4, ICD-10-CM and HCPCS coding.
Prior experience supervising and directing people and other resources to achieve specific end results
Experience working in a matrixed environment preferred

Education / Training:

Bachelor's Degree required
Master's Degree preferred

Physical Requirements:

Environment - Office environment, 25% to 50% travel required.  Employees in roles that require travel will need to be able to qualify for a company credit card or be able to use their own personal credit card for travel expenses and submit for reimbursement.
Physical Requirements - Sitting, standing, walking, and using keyboard.

Join our team today where we are creating a better coordinated, increasingly collaborative, and more efficient healthcare system!

Equal Opportunity/Affirmative Action Statement

Change Healthcare is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, genetic information,  national origin, disability, or veteran status. To read more about employment discrimination protections under federal law, read EEO is the Law at and the supplemental information at .

If you need a reasonable accommodation to assist with your application for employment, please contact us by sending an email to  with "Applicant requesting reasonable accommodation" as the subject. Resumes or CVs submitted to this email box will not be accepted.

Click here to view our pay transparency nondiscrimination policy.

Change Healthcare maintains a drug free workplace and conducts pre-employment drug-testing, where applicable, in accordance with federal, state and local laws.

Change Healthcare is an Equal Opportunity Employer. Employment at Change Healthcare is based upon your individual merit and qualifications. We don't discriminate on the basis of race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, physical or mental disability, marital status, protected veteran status or disability, genetic characteristic, or any other characteristic protected by applicable federal, state or local law. We will also make all reasonable accommodations to meet our obligations under the Americans with Disabilities Act (ADA) and state disability laws. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability.

Job Summary

Employment Type:
Full Time Employee
Job type:
Federal Contractor
Skill Based Partner:
Education Level:
No school grade completed
Work Days:
Mon, Tue, Wed, Thu, Fri
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