Texas Licensed Program Integrity Director

A company is looking for a Director of Program Integrity to lead the Program Integrity department focusing on claims editing and fraud prevention.

Key Responsibilities

Lead and oversee all Program Integrity operations

Design, analyze, and improve workflows to increase productivity and efficiency

Develop and implement internal controls ensuring compliance with laws and guidelines

Required Qualifications

5+ years management experience

8+ years' experience in Payment Integrity Audit and Recovery

2+ years' experience in a Managed Care health plan or state agency

Knowledge of ICD-10 and CPT / HCPCS coding guidelines

Certification / Registration / Licensure : Project Management or Six Sigma certification preferred