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
19 hours ago
Job type
  • Full-time
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."
    • Create a job alert for this search

    Director Program • Dallas, TX, US

    Related jobs
    RN Med Surg / Telemetry Nights

    RN Med Surg / Telemetry Nights

    Baylor Scott & White Health • Ennis, TX, US
    Full-time
    Baylor Scott & White Medical Center | Waxahachie, Texas.Full-Time, Nights, (3) 12-hour shifts, 7P-7A.Working with diverse patient population and ability to grow nursing skills • •.Here at Baylor ...Show more
    Last updated: 30+ days ago • Promoted
    Program Manager

    Program Manager

    Leonardo DRS • Dallas, TX, United States
    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: 2 hours ago • Promoted • New!
    Director, Credit Onboarding

    Director, Credit Onboarding

    The Options Clearing Corporation • Dallas, TX, United States
    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: 30+ days ago • Promoted
    Director, Major Gifts - Southwest

    Director, Major Gifts - Southwest

    National Multiple Sclerosis Society • Dallas, TX, United States
    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: 30+ days ago • Promoted
    Side Hustle Project Lead

    Side Hustle Project Lead

    Finance Buzz • Palmer, Texas, US
    Full-time +1
    We’re offering a role for someone who wants to lead their own side-income project in their spare time.You’ll explore various proven side hustles, select the ones that fit your lifestyle, and run th...Show more
    Last updated: 30+ days ago • Promoted
    Program Director

    Program Director

    Brain Balance • Allen, Texas, United States
    Full-time
    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: 21 days ago
    Director of Healthcare Operations

    Director of Healthcare Operations

    Beacon Hill • Plano, TX, US
    Permanent
    Our client, a healthcare provider is seeking a permanent Director of Operations to work out of their corporate offices in North Austin, TX. This role is onsite 5 days a week from the hours of 9 : 00 a...Show more
    Last updated: 14 days ago • Promoted
    Travel Rehabilitation Occupational Therapist - $1,958 per week

    Travel Rehabilitation Occupational Therapist - $1,958 per week

    LRS Healthcare - Allied • Ennis, TX, United States
    Permanent
    LRS Healthcare - Allied is seeking a travel Occupational Therapist for a travel job in Ennis, Texas.Job Description & Requirements. LRS Healthcare - Allied Job ID #30I-51939.Pay package is based on ...Show more
    Last updated: 10 days ago • Promoted
    Director of Program Integrity

    Director of Program Integrity

    TalentPlug LLC • Dallas, TX, US
    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: 1 day ago • Promoted
    Director of Asset Management - Multifamily

    Director of Asset Management - Multifamily

    University Partners • Dallas, TX, United States
    Full-time
    Report to : VP of Asset Management, Elevate Property Partners .Location : Downtown Dallas, TX | Travel : 20–25%.About Elevate Property Partners. Elevate Property Partners is a nationally recognized rea...Show more
    Last updated: 4 days ago • Promoted
    Associate Director, Access & Reimbursement - (South)(TX,OK,LA,AZ,AR,NM,AL)(field based)

    Associate Director, Access & Reimbursement - (South)(TX,OK,LA,AZ,AR,NM,AL)(field based)

    Eisai • Dallas, TX, United States
    Full-time
    At Eisai, satisfying unmet medical needs and increasing the benefits healthcare provides to patients, their families, and caregivers is Eisai's human health care (hhc) mission.We're a growing pharm...Show more
    Last updated: 13 days ago • Promoted
    Director of Pharmacy Operations

    Director of Pharmacy Operations

    Frontline Source Group • Richardson, Texas, United States
    Full-time +1
    Director of Pharmacy Operations Our client located in Dallas, TX needs a Director of Pharmacy Operations.Offering weekday hours, no evenings or weekend responsibility. This is a direct hire opportun...Show more
    Last updated: 13 days ago • Promoted
    Director of Managed Care

    Director of Managed Care

    The Remedy Group • Plano, TX, US
    Full-time
    Director of Managed Care — Texas.This role allows you to directly influence contract strategy, reimbursement outcomes, and the overall patient experience. We're seeking a managed care leader who can...Show more
    Last updated: 4 days ago • Promoted
    Director of Nursing

    Director of Nursing

    Zollege • Plano, TX, US
    Full-time
    Be a foundational leader : you'll shape and launch the first accredited LVN / LPN program at Zollege, making a real impact in nursing education and workforce readiness. At Zollege, we believe higher ed...Show more
    Last updated: 14 days ago • Promoted
    Program Director

    Program Director

    Stantec • Plano, TX, US
    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: 30+ days ago • Promoted
    Director of FP&A - Addison - Hybrid (150k-180k + Bonus)

    Director of FP&A - Addison - Hybrid (150k-180k + Bonus)

    LHH • Addison, TX, US
    Full-time
    LHH is seeking a Director of Financial Planning & Analysis (FP&A) on behalf of a rapidly expanding, private equity–backed healthcare organization. This company operates in a high-growth, mul...Show more
    Last updated: 28 days ago • Promoted
    Regional Director of Operations

    Regional Director of Operations

    Delta Dallas • Addison, TX, US
    Full-time
    Regional Director of Operations– Healthcare - Dallas, TX (only local candidates will be considered).Our client in specialized healthcare, is seeking a dynamic and strategic.Regional Director of Ope...Show more
    Last updated: 30+ days ago • Promoted
    Transitional / Interim Director of Pharmacy

    Transitional / Interim Director of Pharmacy

    CompleteRx • Dallas, TX, US
    Temporary
    CompleteRx is looking for a dynamic.Transitional / Interim Director of Pharmacy.The individual will travel and serve as an interim DOP until the hire of a DOP for the hospital.To meet the needs of ou...Show more
    Last updated: 30+ days ago • Promoted