Senior Director of Payment Integrity

Job Summary

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

Key Responsibilities

• Oversee waste, abuse, and fraud investigations, audits, and medical code editing
• Interpret audit results and assist in developing action plans for identified risks
• Develop and implement auditing processes and ensure compliance with regulations

Required Qualifications

• Bachelor's degree in Accounting, Criminal Justice, Finance, Medical Professional, Economics, Operations Management, or related field
• 10+ years of related compliance and/or special investigation experience in managed care or CMS
• Experience in compliance/ERM preferred