Director, Program Integrity

Role Overview

• The Director of Program Integrity provides strategic direction and oversight of the organizational fraud, waste and abuse (FWA) program encompassing conducting routine and targeted claims audits, data analyses, and investigations to detect, prevent, and remediate FWA related to behavioral health, direct medical care, and other healthcare services.
• Responsible for the oversight of the FWA program through the assurance of accurate medical coding, claims processing, compliance with documentation and regulatory requirements, appropriate service utilization, effective overpayment recovery, and prepayment prevention.
• Lead FWA strategy and program integrity efforts through audits, investigations, data analysis, training, and implementation of anti-fraud initiatives that drive compliance and financial recovery.
• Advise leadership on claims risk, regulatory trends, and recovery opportunities while maintaining strong client relationships and supporting team development and certifications.
• Partner with internal teams across operations, legal, clinical, IT, and analytics to support audits, committees, and initiatives that strengthen fraud detection and oversight.
• Serve as the primary liaison to health plans, regulators, law enforcement, and auditors, overseeing external audit responses, regulatory requests, and executive presentations.
• Oversee and continuously enhance the FWA Plan, policies, procedures, reporting, and KPIs to ensure accuracy, transparency, and operational effectiveness.
• Drive innovation by leading training programs, adopting new tools and investigative methods, and managing third-party vendor and partner relationships.
• Mentor and lead a high‑performing team by fostering a culture aligned with Lucet’s values, emphasizing accountability, continuous development, and adaptability to change.

Requirements

• Bachelor’s degree in healthcare, public administration, or related field
• 3+ years of management experience that clearly demonstrates leadership
• 7+ years of experience in healthcare claims auditing, investigations, program integrity, healthcare compliance, or a related area
• 7+ years healthcare/managed care claims, reimbursement, contracting and/or analytics experience
• Experience in developing and implementing audit and/or anti-fraud plans, policies and procedures, training materials, workflow diagrams, standard operating procedures or other documentation
• Proficient with all healthcare coding (CPT4, HCPCS, DRG, ICD-9, ICD-10 & Revenue Codes)
• Experience and familiarity with data analysis and data mining for purposes of fraud detection
• Demonstrated experience in successful overpayment recovery.
• Ability to pass background check upon hire and throughout employment

Benefits

• Comprehensive health benefit options: Medical, dental, and vision coverage
• 401(k) with competitive employer match
• Company-paid life and disability insurance
• Paid parental leave and wellbeing incentives
• Generous paid time off, including volunteer time
• Flexible spending accounts for healthcare and dependent care
• Professional development opportunities and tuition reimbursement
• Remote work flexibility (role-dependent)