Talent.com
Director of Program Integrity
Director of Program IntegrityTalentPlug LLC • Dallas, TX, US
Director of Program Integrity

Director of Program Integrity

TalentPlug LLC • Dallas, TX, US
[job_card.variable_days_ago]
[job_preview.job_type]
  • [job_card.full_time]
[job_card.job_description]

Summary :

  • Our client is seeking a Director of Program Integrity to lead and oversee operations focused on claims editing, fraud prevention, and payment accuracy.
  • This role is essential for ensuring operational excellence and adherence to regulations.

Key Responsibilities :

  • Identifies and analyses the design of jobs, work processes, work flows, etc. for the area and implements appropriate changes to improve effectiveness, productivity, and efficiency.
  • Stays abreast of the latest developments, advancements, and trends in the field by attending seminars / workshops and reading professional journals.
  • Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the area.
  • Develops and monitors annual budgets that ensure the department has the necessary funds to carry out the goals and objectives.
  • Develops, implements, monitors, and revises annual goals and objectives for the department.
  • Selects, trains, schedules, motivates, supervises, and evaluates employees. Schedule and Shift Details
  • Will have to be onsite at least SIX DAYS a month.

    • Required :

  • Bachelor's degree or higher
  • Managed Care (2+ years)
  • Medicaid (1+ years)
  • 1+ years of experience in ANY of the following :

    • ICD10

    Medical Coding

  • ANY of the following valid licenses / certifications :

    • Lean Six Sigma

    Project Management Professional (PMP)

    Experience seeking :

  • 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.
  • Please list the types of Medicaid Health Plans that your candidate is familiar with.
  • HM looking only considering candidates who actually have payment integrity, rather than revenue recovery experience.
  • Payer-focused on preventing overpayments and preventing fraud, waste, and abuse.
  • Health Plan experience, not healthcare system experience
  • Certification / Registration / Licensure Project management or Six Sigma certification - Strongly Preferred.

    • Internal notes :

  • Primarily Works Remote - Must Be On-Site 6 Days Per Month Submission Requirements
  • "By submitting your applicant to this need you are acknowledging that you have checked and have no inclination that your candidate has applied directly to this position. Any candidate that has applied directly is not eligible to be on boarded through an agency."
    • [job_alerts.create_a_job]

    Director Program • Dallas, TX, US

    [internal_linking.related_jobs]
    Director, Payment Integrity - Hybrid

    Director, Payment Integrity - Hybrid

    Parkland Health and Hospital System • Dallas, TX, US
    [job_card.full_time]
    Are you looking for a career that offers both purpose and the opportunity for growth? Parkland Community Health Plan (PCHP) is a proud member of the Parkland Health family.PCHP is a Medicaid Manage...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Director of Programming - StrongerLife

    Director of Programming - StrongerLife

    Kidstrong • Frisco, TX, US
    [job_card.full_time]
    Are you looking for that workplace where you can be part of a fun, energetic, and professional team that loves what they do? Our corporate office is growing and we are looking for a Director Of Pro...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Director, ARO Operations

    Director, ARO Operations

    FinThrive • Plano, TX, United States
    [job_card.full_time]
    The Director, ARO Operations is an instrumental leader within the AR Optimizer team that will drive operational excellence and continued growth for the business line. As the Director, you will lead ...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Senior Program Director

    Senior Program Director

    CESO Inc • Dallas, Texas, United States, 75201
    [job_card.full_time]
    Are you seeking purpose, challenge, and talented colleagues? With a diverse portfolio of residential, energy, commercial, light industrial and public programs, CESO has the opportunity for you to ...[show_more]
    [last_updated.last_updated_30]
    Program Manager

    Program Manager

    Leonardo DRS • Dallas, TX, United States
    [job_card.full_time]
    The Electro Optical InfraredSystems (EOIS) line of business within DRS has locations in Dallas and Austin, TX, Melbourne, FL, and Cypress, CA. EOIS develops, manufactures, and supports infrared and ...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Director, Credit Onboarding

    Director, Credit Onboarding

    The Options Clearing Corporation • Dallas, TX, United States
    [job_card.full_time]
    THIS POSITION IS NOT ELIGIBLE FOR VISA SPONSORSHIP • • • • •.This role will be primarily responsible for safeguarding OCC by ensuring that Credit Risk Management (CRM) only recommends new clearing membe...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Director, Major Gifts - Southwest

    Director, Major Gifts - Southwest

    National Multiple Sclerosis Society • Dallas, TX, United States
    [job_card.full_time]
    The National Multiple Sclerosis Society mobilizes people and resources to drive research for a cure and to address the challenges of everyone affected by MS. To fulfill this mission, the Society fun...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Program Director

    Program Director

    Brain Balance • Allen, Texas, United States
    [job_card.full_time]
    [filters_job_card.quick_apply]
    Brain Balance is seeking a professional, energetic, and organized individual who loves children to fill the Program Director position in our Allen, TX center. Must love working with children and has...[show_more]
    [last_updated.last_updated_variable_days]
    Director of FP & A

    Director of FP & A

    Loss Prevention Services, LLC • Red Oak, TX, US
    [job_card.full_time]
    Director of FP&A Dallas, TX (Onsite).Company : Loss Prevention Services (MS), LP.About Loss Prevention Services (MS), LP. Loss Prevention Services (MS), LP (LPS) is a technology-enabled informati...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    DIRECTOR OF COOPERATIVE PROGRAM

    DIRECTOR OF COOPERATIVE PROGRAM

    Texas Baptists • Dallas, TX, US
    [job_card.full_time]
    Texas Baptists is a convention of more than 5,300 Baptist churches.Active membership at a church supportive of Texas Baptists is a condition of employment. Texas Baptists makes all employment decisi...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Director of Program Integrity

    Director of Program Integrity

    TalentPlug LLC • Dallas, TX, US
    [job_card.full_time]
    Our client is seeking a Director of Program Integrity to lead and oversee operations focused on claims editing, fraud prevention, and payment accuracy. This role is essential for ensuring operationa...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Pain Management

    Pain Management

    CompHealth • Ennis, Texas, US
    [job_card.full_time]
    Pain Management physician job in Texas : Whether you are searching for a position in your area or in another state, we have professionals to help you achieve your goals through our relationships wi...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Director of Program Integrity

    Director of Program Integrity

    Nurchure Staffing Solutions • Dallas, TX, United States
    [job_card.full_time]
    [filters_job_card.quick_apply]
    Director of Program Integrity Dallas, TX 75201 Full-time[show_more]
    [last_updated.last_updated_variable_days]
    Director, FIU Innovation & Program Transformation

    Director, FIU Innovation & Program Transformation

    Capital One • Plano, TX, United States
    [job_card.full_time]
    A leading banking and technology company is seeking a Director of Financial Intelligence Unit Program Innovation to lead and drive innovation within the FIU. Responsibilities include managing financ...[show_more]
    [last_updated.last_updated_1_day] • [promoted]
    Director of I / T Systems

    Director of I / T Systems

    FAIRMONT • Dallas, TX, US
    [job_card.full_time]
    Fairmont Dallas, located in the Arts District of downtown Dallas, offers 545 elegant guestrooms and suites, with over 73,000 square feet of flexible meeting space. For over 50 years, Fairmont Dallas...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Program Director

    Program Director

    Stantec • Plano, TX, US
    [job_card.full_time]
    Program Director / Program Manager.When you care deeply about the work you do, it's rewarding to see it through from concept to completion. We partner with clients to provide both program management...[show_more]
    [last_updated.last_updated_30] • [promoted]
    A / R Director

    A / R Director

    Vaco by Highspring • Addison, TX, US
    [job_card.permanent]
    Vaco has partnered with one of our PE-backed clients to look for an Accounts Receivable Director.They are in "growth / acquisition" mode with a ton of accounting projects going on and need someone wi...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Director of Consulting

    Director of Consulting

    Mantis Innovation • Dallas, TX, US
    [job_card.full_time]
    Mantis Innovation provides managed facility services and turnkey program management with technology-enabled solutions that target the entire building footprint. We look at the entire facility—...[show_more]
    [last_updated.last_updated_30] • [promoted]