Talent.com
Director of Program Integrity
Director of Program IntegrityTalentPlug LLC • Dallas, TX, US
[error_messages.no_longer_accepting]
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.similar_jobs]
    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]
    Director of I / T Systems

    Director of I / T Systems

    The Fairmont Hotel • Dallas, TX, United States
    [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

    The Little Gym of Mockingbird & Abrams / Preston & Forest • Dallas, TX, US
    [job_card.full_time]
    Lifes too short to not work someplace awesome! If you have tons of energy, love kids, and are looking for a way to give back to your community, you may be the person we are looking for!.Why is The ...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Regional Director, EM-0301-00 (FDIC-Only)

    Regional Director, EM-0301-00 (FDIC-Only)

    US Government Jobs • Dallas, TX, US
    [job_card.full_time]
    These positions are located in the Divisions of Risk Management Supervision (RMS) and Depositor and Consumer Protection (DCP), Regional Offices of the Federal Deposit Insurance Corporation, as foll...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    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_30] • [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 Sustainability

    Director of Sustainability

    Public Storage • Frisco, TX, US
    [job_card.full_time]
    Since opening our first self-storage facility in 1972,.Europe, and more than 170 million net rentable square feet of real estate, we're also one of the largest landlords.And, our employees have...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Manager Revenue Integrity

    Manager Revenue Integrity

    Baylor Scott & White Health • Dallas, TX, United States
    [job_card.full_time]
    The Manager of Revenue Integrity performs duties of moderate to high complexity, judgement, and scope under the direction of the Baylor Scott & White Health's (BSWH) Director of Revenue Integrity.T...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Clinical Excellence Program Director

    Clinical Excellence Program Director

    #REF! • Frisco, Texas, USA
    [job_card.full_time]
    Clinical Excellence Program Manager.Bring your passion to Texas Health so we are Better Together.Texas Health Frisco - 12400 Dallas Parkway Frisco Texas 75033. Opportunity to advance nursing profes...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Director of Program Integrity

    Director of Program Integrity

    Lancesoft INC • Dallas, TX, US
    [job_card.full_time] +1
    Title - Director of Program Integrity.Program Integrity department and associated functions with focus on claims editing, fraud, waste, and abuse (FWA) prevention, and payment accuracy.Accountable ...[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]
    Program Director

    Program Director

    Tech Digital • Dallas, TX, US
    [job_card.full_time]
    Extensive experience overseeing large IT programs PMO- several simultaneous workstreams (oversee timelines, schedules, deliverables, staffing etc. IT large implementation program.Work with vendors, ...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Director, QA Data Integrity

    Director, QA Data Integrity

    Thermo Fisher • Dallas, TX, US
    [job_card.full_time]
    Adherence to all Good Manufacturing Practices (GMP) Safety Standards, Office.The QA Director, Global Data Integrity Program will own the Global DI Program that ensures compliance to regulatory requ...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Director, Program Management Pharma Relations

    Director, Program Management Pharma Relations

    Soleo Health Inc • Frisco, TX, US
    [job_card.full_time]
    Director of Program Management in Pharma Relations.Join us in simplifying complex care!.Affordable Medical, Dental, & Vision Insurance Plans. Company Paid Disability & Basic Life Insurance.H...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Director, Product Integrity & Compliance

    Director, Product Integrity & Compliance

    JCPenney • Dallas, TX, United States
    [job_card.full_time]
    A leading retail company is seeking a Director of Product Integrity to govern quality and compliance for its product portfolio. This role includes overseeing product safety initiatives, leading a cr...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Associate Director, Program Manager (Value Stream Leader) – Platform Connected Technology (Onsite)

    Associate Director, Program Manager (Value Stream Leader) – Platform Connected Technology (Onsite)

    RTX • Richardson, Texas, USA
    [job_card.full_time]
    HTX36 : Richardson TX 3200 E Renner Rd Richardson TX 75082-2402 USA.Person or Immigration Status Requirements : .Collins Aerospace an RTX company is a leader in technologically advanced andintellige...[show_more]
    [last_updated.last_updated_variable_hours] • [promoted] • [new]
    Senior Program Director

    Senior Program Director

    CESO, Inc. • Dallas, TX, US
    [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 f...[show_more]
    [last_updated.last_updated_30] • [promoted]
    MFM Regional Director One Mission Society Engaging the One to Reach the Many

    MFM Regional Director One Mission Society Engaging the One to Reach the Many

    Missio Nexus • Town Of Texas, WI, United States
    [job_card.full_time]
    Represent Men for Missions (MFM) in Montana or Texas using your skills and contacts to challenge laymen to become involved with MFM through short-term mission involvement.Relate to churches, indivi...[show_more]
    [last_updated.last_updated_30] • [promoted]