Vālenz® Health

Compliance

• Serve as the primary compliance liaison for Payment Integrity and Payment Operations, providing strategic guidance on regulatory and operational compliance matters.
• Interpret, analyze, and operationalize applicable regulatory requirements, including the No Surprises Act (NSA), Fraud, Waste & Abuse (FWA) laws, CMS requirements, and state Department of Insurance (DOI) regulations impacting payment and billing practices.
• Provide compliance oversight and guidance related to payment workflows, reimbursement methodologies, claims administration processes, and product development initiatives.
• Partner cross-functionally with operational leaders to identify, assess, and mitigate financial and regulatory compliance risks associated with payment and claims functions.
• Monitor and evaluate emerging regulatory developments, enforcement trends, and industry guidance to determine operational impact and support implementation of required changes.
• Support the development, review, implementation, and maintenance of financial and payment-related policies, procedures, and standard operating procedures (SOPs).
• Participate in high-risk initiatives, system implementations, process enhancements, and product changes to ensure compliance considerations are appropriately addressed.
• Assist with incident response activities involving payment disputes, FWA-related escalations, regulatory inquiries, and other compliance-related matters.
• Support internal audits, external audits, client audits, and regulatory examinations by coordinating documentation, responding to inquiries, and ensuring audit readiness.
• Collaborate with Corporate Compliance and cross-functional stakeholders on issue intake, triage, investigation support, tracking, corrective action planning, and resolution activities.
• Develop and deliver training, education, and compliance guidance to internal stakeholders regarding applicable regulatory requirements, policies, and operational expectations.
• Maintain accurate and organized documentation supporting compliance oversight activities, monitoring efforts, investigations, and audit preparedness.

Senior Compliance Specialist – Payment Integrity

• Serve as the primary compliance liaison for Care Management and Utilization Management operations, providing strategic guidance and oversight to ensure adherence to applicable regulatory and accreditation requirements
• Interpret, assess, and operationalize regulatory standards, including CMS Medicare Advantage and Managed Care requirements, NCQA and URAC accreditation standards, Utilization Review and Utilization Management regulations, and 42 CFR Part 2 requirements, as applicable
• Oversee and support the organization’s multi-state Utilization Management licensing program by tracking licensing requirements across applicable jurisdictions, coordinating license applications and renewals, maintaining supporting documentation, and partnering with operational leaders to ensure ongoing compliance with licensing conditions and regulatory obligations
• Provide compliance guidance and subject matter expertise related to clinical workflows, operational processes, policy development, and system implementations impacting Care operations
• Support the full lifecycle management of Care-related policies, standard operating procedures, and associated documentation
• Monitor regulatory developments and emerging compliance requirements, evaluate operational impact, and communicate relevant updates and recommendations to key stakeholders
• Participate in high-risk initiatives, operational enhancements, and product or process changes to ensure compliance considerations are appropriately addressed
• Support organizational readiness for audits, regulatory reviews, and accreditation activities, including NCQA and URAC surveys
• Assist with incident response activities involving Care operations, including privacy-related inquiries, compliance investigations, and regulatory escalations
• Collaborate with Corporate Compliance and cross-functional teams on issue intake, triage, tracking, remediation, and resolution efforts
• Provide education, training, and ongoing guidance to internal stakeholders regarding applicable regulatory and compliance requirements
• Maintain accurate and organized documentation to support compliance activities, regulatory inquiries, audits, and accreditation requirements

Senior Compliance Specialist – Care Management Programs

Auditor

• Review medical bills to identify appropriate billing, coding, and savings opportunities.
• Analyze and resolve claim discrepancies that require a deeper level of expertise beyond initial review.
• Collaborate with the Negotiation team to resolve more complex claim issues and secure additional savings.
• Communicate findings to clients through detailed Bill Review Reports and assist in discussing complex bill-related inquiries.
• Evaluate and respond to bill reconsideration requests, including those requiring additional research or analysis.
• Handle escalated provider inquiries, resolve disputes, and conduct direct negotiations for billing discrepancies.
• Provide guidance and mentor junior analysts in claim review best practices.
• Assist in identifying trends in billing issues, proposing system/process improvements, and contributing to policy development.
• Support training efforts by educating internal teams and clients on changes to codes, edits, and bill review procedures.
• Work cross-functionally with internal teams to identify and implement process efficiencies that improve savings and client satisfaction.
• Ensure compliance with HIPAA and other regulatory standards.
• Perform other duties as assigned.

Certified Medical Claims Auditor

Bilingual

• Receive inbound calls, faxes, and web requests from providers and/or clients
• Initiate and facilitate the authorization process in accordance with established health plan policies and procedures
• Document demographic information obtained from telephonic, fax, or emailed requests within the care management system
• Make outbound calls to follow up on discharge information or request updated clinical information as necessary for concurrent review
• Screen inquiries to determine the services that require certification at the time of the inquiry
• Obtain clinical information and forward the caller to the clinical staff for completion of the review
• Provide certification based upon scripted clinical algorithms or benchmark Length of Stay
• Collaborate and effectively communicate with internal and external partners
• Stay up to date on Summary Plan Documents and other related resources related to service requests
• Ensure applicable URAC standards, Confidentiality/HIPAA standards, and internal policies, practices, and productivity metrics are met
• Performs other related duties as assigned by supervisor.

Bilingual Intake Coordinator

Operations

• Collaborate with business partners to gather, interpret, and document business requirements, including data discovery, policies, procedures and analysis.
• Collaborate with cross-functional teams, including Product, Client Delivery, Data Integration, Engineering and Analytics, to enhance existing data workflows and processes.
• Assist in supporting technical teams and business stakeholders, translating complex data concepts into clear, actionable insights.
• Utilize SQL and related tools to support data-driven decision-making through reports, dashboards, and data extracts.
• Ensure data accuracy, integrity, and consistency across systems through data validation, reconciliation, and quality checks.
• Conduct file testing during implementations to validate data accuracy, completeness, and compliance with specifications.
• Conduct root cause analysis on complex data issues and ensure findings are documented and incorporated into process improvements.
• Troubleshoot application or process issues, document findings, and recommend solutions.
• Work within Databricks and related data platforms to support, document, and optimize data workflows and pipelines.
• Work within Azure DevOps to identify, track and maintain individual and team initiatives.
• Support automation and optimization of data-related tasks and reporting processes to improve efficiency.
• Investigate and troubleshoot data issues, performing root cause analysis with guidance as needed.

Data Operations Analyst

Business Operations

Business Operations Analyst

Data Analyst

• Lead, coach, and develop a team of Analysts by providing technical direction, reviewing deliverables, and guiding problem-solving approaches.
• Define and execute the provider analytics roadmap in alignment with product and enterprise data strategy.
• Set clear performance expectations, support professional development, and manage ongoing performance.
• Serve as a subject matter expert in provider data, leading complex analyses to establish accurate provider identity, network status, affiliations, and hierarchy across multiple data sources.
• Design and support scalable, production-grade analytics workflows using SQL, Python, and Databricks.
• Ensure the accuracy, quality, and integrity of analytical outputs through strong validation and review practices.
• Partner cross-functionally with Data Engineering, Product, Application Development, and Client Success to deliver solutions, resolve complex issues, and support strategic initiatives.
• Translate complex analytical findings into clear, actionable insights for both technical and non-technical audiences.
• Identify and implement process improvements to enhance efficiency, scalability, and data reliability.
• Evaluate and introduce emerging technologies and best practices to strengthen provider data capabilities.
• Manage and track work through project management tools such as Azure DevOps and Salesforce.

Manager, Healthcare Data Analytics

Marketing Operations

• Execute ongoing quality control on outgoing communications to ensure accuracy and compliance, including proofing, hyperlink validation, and QR code testing.
• Monitor automated email activity, including bounce reports and delivery issues, and execute corrective actions as needed.
• Ensure timely delivery of all engagement requests and campaigns in alignment with established SLAs.
• Support execution of monthly automated campaigns across email, print, and SMS channels, including providing backup coverage as needed.
• Support fulfillment of Salesforce cases submitted by Client Success Managers, including providing backup coverage and assisting with more complex or escalated requests.
• Serve as a support resource for Client Success Managers, including handling more complex troubleshooting and escalations.
• Provide cross-functional support and backup coverage across engagement operations to ensure continuity of service.
• Collaborate with internal teams to support engagement initiatives and campaign execution.
• Support the preparation and upload of member lists for campaign execution and serve as backup for more complex list management needs.
• Update SMS and email templates and workflows within the platform as directed.
• Configure customized in-app guidance for clients using WalkMe.
• Support application and product fulfillment testing as assigned.
• Maintain and update documentation for processes, workflows, and standard operating procedures.
• Identify process issues and share observations with manager.
• Review targeted communication audits to support outreach effectiveness and identify data gaps for resolution.
• Assess campaign performance data across email, print, and SMS channels.
• Compile and summarize campaign results in a clear, standardized format for manager review.
• Review Salesforce audit findings, identify data discrepancies, and implement updates based on manager direction.
• Perform other duties as assigned.

Marketing Operations Coordinator

Certified Medical Coding Auditor

Vice President

• Own the overall performance, growth, and financial health of Valenz Bluebook, with direct accountability for contribution margin, revenue growth, and forecast accuracy.
• Define and execute the product strategy and roadmap, prioritizing initiatives that increase adoption, engagement, savings, and long-term client value.
• Lead performance management by tracking and acting on key indicators including utilization, conversion, savings, rewards engagement, and member satisfaction.
• Use data, experimentation, and market insight to continuously evolve the product and strengthen its role within the broader Valenz ecosystem.
• Own and drive go-to-market strategy for Valenz Bluebook, partnering with Marketing and Member Engagement on positioning, messaging, launch execution, and ongoing optimization to maximize adoption, awareness, and revenue performance.
• Partner with Revenue and Sales as a product evangelist, directly supporting key deals, renewals, and client conversations by clearly articulating product value, differentiation, and performance.
• Serve as a C-suite-facing product leader, confidently presenting product strategy, performance, and value to clients, partners, and executive stakeholders.
• Partner with Technology to deliver roadmap initiatives on time, ensuring solutions are scalable, reliable, and positioned for successful market adoption.
• Identify, evaluate, and execute partnerships or integrations that expand capabilities, differentiation, and revenue potential.
• Partner with Finance on pricing strategy, margin management, and forecasting, and with Legal on contract structure and governance.
• Serve as the executive owner and internal authority for Valenz Bluebook, aligning cross-functional teams around priorities, outcomes, and performance expectations.

VP, Product & Commercial Strategy

Financial Planning and Analysis

• Own the end-to-end revenue forecasting process across multiple revenue streams
• Build and maintain driver-based models reflecting pipeline activity, conversion, implementation timing, and product mix
• Establish and lead a consistent forecasting cadence to improve accuracy, transparency, and accountability
• Serve as the primary finance partner to Sales and Revenue Operations
• Lead pipeline and forecast reviews, ensuring alignment across commercial and finance teams
• Analyze performance across product lines, bundled offerings, and cross-sell activity
• Identify key drivers impacting revenue and provide actionable insights
• Prepare and present materials for executive leadership and private equity stakeholders
• Define and standardize revenue KPIs across systems and stakeholders
• Manage and develop the revenue FP&A team

Director, Revenue FP&A

Administration

• Administers, owns, and maintains the internal contract management system (CLM), ensuring accuracy, completeness, and timely updates of contract records.
• Manages and maintains contract templates, incorporating approved language and ensuring consistency within the CLM.
• Prepares, drafts, reviews, and maintains a variety of contracts and related documentation, including client agreements, amendments, and renewals.
• Ensures contracts comply with internal policies and procedures, coordinating with the legal team to address non-standard terms.
• Tracks contract lifecycle activities in the CLM, including approvals, execution, renewals, and expirations, and proactively follows up on pending items with internal teams.
• Communicates with and supports internal stakeholders and external parties by responding to inquiries and facilitating clear communication throughout the contracting process as needed.
• Collaborates cross-functionally with sales, client success, operations, and other teams to support timely and accurate contract execution.
• Identifies opportunities to improve contract processes, templates, and system usage to enhance efficiency and reduce risk.
• Maintains organized contract files and documentation in accordance with company policies and audit requirements.
• Performs other related duties as assigned.

Contract Administrator

• Lead enterprise-wide continuous improvement initiatives utilizing Lean Six Sigma and DMAIC methodologies to drive measurable efficiencies, enhance quality, reduce waste, and optimize operational performance.
• Design and implement scalable process improvements that strengthen accuracy, throughput, and compliance in payment integrity operations, ensuring alignment with regulatory requirements, client expectations, and organizational performance goals.
• Leverage technology, data analytics, and automation tools to streamline workflows, reduce manual touchpoints, improve cycle times, and enhance reporting transparency.
• Partner with technical teams to evaluate and implement process automation solutions that support sustainable operational gains.
• Facilitate cross-functional workshops and working sessions, including value stream mapping, process mapping, and root cause analysis (RCA), to uncover operational gaps, identify bottlenecks, and prioritize high-impact improvement opportunities.
• Collaborate closely with Implementation, Client Success, Product, and Core Operations teams to design, document, and operationalize end-to-end workflows supporting new client onboarding, product enhancements, and service expansions within the Payment Integrity portfolio.
• Establish standardized operating procedures (SOPs) and governance frameworks to ensure process consistency, scalability, and repeatability across pre-payment and post-payment integrity functions.
• Identify, assess, and mitigate operational risks that may affect service delivery, financial outcomes, regulatory compliance, or client experience, implementing controls and monitoring mechanisms to ensure ongoing stability and performance.
• Develop and maintain comprehensive project documentation, including charters, business cases, stakeholder analyses, process documentation, KPIs, dashboards, and post-implementation reviews to ensure transparency and accountability.
• Define and track key performance indicators (KPIs) to measure operational effectiveness, quantify improvement impact, and support data-driven decision-making across the Payment Integrity vertical.
• Champion a culture of continuous improvement, providing coaching and guidance to operational leaders and frontline teams to build internal capability in problem-solving, process discipline, and performance optimization.
• Perform other duties as assigned. Reasonable accommodation may be made to enable individuals with disabilities to perform essential duties.