Payment Integrity Director

Job Summary

Overseeing prepay waste and abuse reviews, the full-time salaried Payment Integrity Director will manage coding, editing, and audit programs while ensuring compliance with state and federal regulations in a remote setting.

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, or related field, or equivalent experience
• 7+ years of finance, accounting, operations, or auditing experience
• Experience in claims operations preferred
• 7+ years of compliance or enterprise risk management experience preferred