Director of Payment Integrity

Job Summary

A company is looking for a Director of Payment Integrity.

Key Responsibilities

• Oversee prepay editing and retrospective audits to ensure accurate and timely payments of coding and pricing issues
• Interpret audit results, develop action plans, and present findings to senior management
• Design, develop, and implement internal payment integrity edit and audit programs, policies, and procedures

Required Qualifications

• Bachelor's degree in Accounting, Finance, Nursing, Operations Management, Healthcare related, or equivalent experience
• 7+ years of finance, accounting, operations, or auditing experience
• Experience in claims operations preferred
• 7+ years of compliance/ERM experience preferred