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 solid 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:

1. 837 Professional (P) & Institutional (i) Claims
2. 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.
- Solid analytical, financial, and operational management skills.
- Excellent communication, presentation, and negotiation skills.

Key Responsibilities Client Leadership & Relationship Management

Pre-Implementation & Solution Design

Post-Implementation Management

Technology & Innovation Partnership

Revenue Management & Financial Oversight

Strategic Leadership & Organizational Vision

Cross-functional collaboration

Payment Integrity Leadership

Interested candidates please mail resume to [email protected]

📌 Director - US Healthcare Operations (Underpayment Recovery- Payment Integrity) (India)
🏢 T3Cogno
📍 India