Director of Program Integrity

Job Description

Job Description

Title - Director of Program Integrity

Type - Full Time / Permanent

Location - Dallas, TX

Hourly Range -    $61.06 - $82.45 - $103.85 Per Hour

Summary :

The  Director of Program Integrity  provides leadership oversight and directs the operations for the Program Integrity department and associated functions with focus on claims editing, fraud, waste, and abuse (FWA) prevention, and payment accuracy. Accountable for supporting commitment to operational excellence, cost containment, and adherence to state and federal requirements.

Job Responsibilities :

1. Identifies and analyzes the design of jobs, work processes, work flows, etc. for the area and implements appropriate changes to improve effectiveness, productivity, and efficiency that support the overall goals.

2. Stays abreast of the latest developments, advancements, and trends in the field by attending seminars / workshops, reading professional journals, actively participating in professional organizations, and / or maintaining certification or licensure. Integrates knowledge gained into current work practices.

3. Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and customer requirements. Seeks advice and guidance as needed to ensure proper understanding.

Benefits :

Medical

Dental

Vision

Life Insurance

Disability Insurance

Flexible Spending Accounts

And more!

Experience :

• Five (5) years of management experience - Required.
• Eight (8) years of experience in Payment Integrity Audit and Recovery with knowledge of audit strategies such as Data Mining, Clinical Medical Record Review, and Bill Audit Recovery / Program Integrity experience - Strongly Preferred.
• 2 years of experience in a Managed Care health plan or state agency - Required.
• Knowledge of ICD-10 and CPT / HCPC coding guidelines and terminology - Required.
• Eight (8) years of experience in a comparable position working in Texas Medicaid or Medicaid Managed Care may be considered in lieu of a bachelor’s degree.
• 5 Years of Texas Medicaid, Managed Care Health Plan or State agency experience - Strongly Preferred.

Certification / Registration / Licensure

• Project management or Six Sigma certification - Strongly Preferred.

Company Description

LanceSoft is rated as one of the largest staffing firms in the US by SIA. Our mission is to establish global cross-culture human connections that further the careers of our employees and strengthen the businesses of our clients. We are driven to use the power of our global network to connect businesses with the right people, and people with the right businesses without bias. We provide Global Workforce Solutions with a human touch.

Company Description

LanceSoft is rated as one of the largest staffing firms in the US by SIA. Our mission is to establish global cross-culture human connections that further the careers of our employees and strengthen the businesses of our clients. We are driven to use the power of our global network to connect businesses with the right people, and people with the right businesses without bias. We provide Global Workforce Solutions with a human touch.