Director of Program Integrity (Days)

Job Description

Job Description

Job 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.

Requirements :

• 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 - Required.
• HM looking only considering candidates who actually have payment integrity, rather than revenue recovery experience. Payer-focused on preventing over payments and preventing fraud, waste, and abuse. Health Plan experience, not healthcare system experience.

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.