Senior Director of Payment Integrity

Job Summary

A company is looking for a Senior Director, Payment Integrity - Audit Programs.

Key Responsibilities

• Provide strategic leadership for enterprise payment integrity audit programs, including prepayment and post payment audits
• Design, implement, and continuously improve audit strategies, methodologies, and governance standards
• Oversee clinical, coding, pricing, and policy audit activities to reduce improper payments and improve claims accuracy

Required Qualifications

• Bachelor's degree in Healthcare Administration, Nursing, Finance, Accounting, Business, Operations Management, or a related field required
• Master's degree in Business, Healthcare Administration, Public Health, or related field preferred
• 10+ years of experience in Payment Integrity, healthcare auditing, claims operations, reimbursement methodologies, or managed care operations
• 5+ years experience managing prepay edits, postpay audits, or fraud, waste, and abuse programs required
• Proficiency in ICD-10-CM/PCS, MS-DRG, and APR-DRG