MetaSense Inc
Perm - Leadership - Director of Program Integrity (Days) Dallas, TX
MetaSense Inc, Dallas, Texas, United States, 75215
Overview
Perm - Leadership - Director of Program Integrity (Days) Dallas, TX. This role provides leadership oversight and directs the operations for the Program Integrity department with a focus on claims editing, fraud, waste, and abuse (FWA) prevention, and payment accuracy. Accountable for supporting Parkland Community Health Plan’s (PCHP) commitment to operational excellence, cost containment, and adherence to state and federal requirements. Base pay range
$61.06/hr - $103.85/hr Hourly Range:
Min $61.06 Mid $82.45 Max $103.85 Responsibilities
Identifies and analyzes the design of jobs, work processes, and workflows for the area and implements appropriate changes to improve effectiveness, productivity, and efficiency that support the overall goals of PCHP. Stays abreast of the latest developments and trends in the field by attending seminars/workshops, reading professional journals, and participating in professional organizations; integrates knowledge into current work practices. Maintains knowledge of applicable rules, regulations, policies, laws and guidelines; develops internal controls to promote adherence with applicable laws, accreditation requirements, and customer requirements. Develops and monitors annual budgets to ensure the department has necessary funds to carry out goals and objectives. Develops, implements, monitors, and revises annual goals and objectives to support the missions and objectives of PCHP. Directs staffing: selects, trains, schedules, motivates, supervises, and evaluates employees; handles disciplinary actions up to termination; ensures opportunities for knowledge development. Qualifications
Five (5) years of management experience – Required. Eight (8) years of experience in Payment Integrity Audit and Recovery with knowledge of audit strategies (Data Mining, Clinical Medical Record Review, Bill Audit Recovery/Program Integrity) – Strongly Preferred. Two (2) years of experience in a Managed Care health plan or state agency – Required. Knowledge of ICD-10 and CPT/HCPC coding guidelines – Required. Eight (8) years of experience in a comparable position in Texas Medicaid or Medicaid Managed Care may substitute for a bachelor’s degree; five (5) years of Texas Medicaid/Managed Care/State agency experience – Strongly Preferred. Certification/Registration/Licensure: Project management or Six Sigma certification – Strongly Preferred. Benefits
Medical Dental Vision Life Insurance Disability Insurance Flexible Spending Accounts And more Experience
Five (5) years of management experience – Required. Eight (8) years of experience in Payment Integrity Audit and Recovery – Strongly Preferred. Two (2) years of experience in a Managed Care health plan or state agency – Required. Knowledge of ICD-10 and CPT/HCPC coding guidelines – Required. Seniority level
Entry level Employment type
Full-time Job function
Legal Industries
Hospitals and Health Care
#J-18808-Ljbffr
Perm - Leadership - Director of Program Integrity (Days) Dallas, TX. This role provides leadership oversight and directs the operations for the Program Integrity department with a focus on claims editing, fraud, waste, and abuse (FWA) prevention, and payment accuracy. Accountable for supporting Parkland Community Health Plan’s (PCHP) commitment to operational excellence, cost containment, and adherence to state and federal requirements. Base pay range
$61.06/hr - $103.85/hr Hourly Range:
Min $61.06 Mid $82.45 Max $103.85 Responsibilities
Identifies and analyzes the design of jobs, work processes, and workflows for the area and implements appropriate changes to improve effectiveness, productivity, and efficiency that support the overall goals of PCHP. Stays abreast of the latest developments and trends in the field by attending seminars/workshops, reading professional journals, and participating in professional organizations; integrates knowledge into current work practices. Maintains knowledge of applicable rules, regulations, policies, laws and guidelines; develops internal controls to promote adherence with applicable laws, accreditation requirements, and customer requirements. Develops and monitors annual budgets to ensure the department has necessary funds to carry out goals and objectives. Develops, implements, monitors, and revises annual goals and objectives to support the missions and objectives of PCHP. Directs staffing: selects, trains, schedules, motivates, supervises, and evaluates employees; handles disciplinary actions up to termination; ensures opportunities for knowledge development. Qualifications
Five (5) years of management experience – Required. Eight (8) years of experience in Payment Integrity Audit and Recovery with knowledge of audit strategies (Data Mining, Clinical Medical Record Review, Bill Audit Recovery/Program Integrity) – Strongly Preferred. Two (2) years of experience in a Managed Care health plan or state agency – Required. Knowledge of ICD-10 and CPT/HCPC coding guidelines – Required. Eight (8) years of experience in a comparable position in Texas Medicaid or Medicaid Managed Care may substitute for a bachelor’s degree; five (5) years of Texas Medicaid/Managed Care/State agency experience – Strongly Preferred. Certification/Registration/Licensure: Project management or Six Sigma certification – Strongly Preferred. Benefits
Medical Dental Vision Life Insurance Disability Insurance Flexible Spending Accounts And more Experience
Five (5) years of management experience – Required. Eight (8) years of experience in Payment Integrity Audit and Recovery – Strongly Preferred. Two (2) years of experience in a Managed Care health plan or state agency – Required. Knowledge of ICD-10 and CPT/HCPC coding guidelines – Required. Seniority level
Entry level Employment type
Full-time Job function
Legal Industries
Hospitals and Health Care
#J-18808-Ljbffr