Manager, Program Integrity

Role Overview

• Manages day to day operations of Program Integrity Department.
• Ensures compliance with all federal, state, and other regulations while maintaining the integrity of all auditing data and reports.
• Conducts periodic compliance and performance reviews of auditor cases and activity.
• Improves the balance of complexity versus-value to increase potential impact and returns.
• Successfully promotes and ensures audits are fact based, unbiased, comprehensive, and provides comprehensive informative findings.
• Guides others to develop build and update work plans, tasks, timelines, measurements, and reports.
• Negotiates settlements and oversees vendor relationships and deliverables that support corporate business decisions.
• Compiles and presents summaries of complex audit activities in a professional format to the appropriate internal or external entities.
• Prioritizes and manages audits to achieve savings, pursue overpayment recoveries and changes in behavior.
• Participates in and coordinates Provider Appeals process specific to overpayment demands.
• Designs and implements wide-ranging, global programs.
• Organizes and develops initiatives across the enterprise which respond to change in managed care.
• Prioritizes time-sensitive requests and meet urgent and tight deadlines.
• Act as a resource on compliance issues or questions related to auditing and monitoring activities.

Requirements

• High School Diploma or Equivalent (GED)
• (Required)
• Minimum of 2 years-Managerial/Supervisory (Required)
• Minimum of 7 years-Relevant experience* (Required)
• Skills: Analytical Thinking, Computer Coding, Critical Thinking, Fraud Detection And Prevention, Fraud Management, Insurance Industry, Leadership.

Benefits

• We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners.
• We encourage an atmosphere of collaboration, cooperation and collegiality.