Director of Program Integrity jobs in United States
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LanceSoft, Inc. · 3 months ago

Director of Program Integrity

LanceSoft, Inc. is rated as one of the largest staffing firms in the US by SIA, and they are seeking a Director of Program Integrity to provide leadership oversight and direct the operations for the Program Integrity department. This role focuses on claims editing, fraud, waste, and abuse prevention, and payment accuracy while ensuring adherence to operational excellence and regulatory requirements.

Information Technology
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Growth Opportunities
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H1B Sponsor Likelynote

Responsibilities

Identifies and analyzes the design of jobs, work processes, work flows, etc. for the area and implements appropriate changes to improve effectiveness, productivity, and efficiency that support the overall goals
Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices
Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and customer requirements. Seeks advice and guidance as needed to ensure proper understanding

Qualification

Payment Integrity AuditICD-10 CodingCPT/HCPC CodingProject Management CertificationSix Sigma CertificationData MiningManagement ExperienceClinical Medical Record ReviewBill Audit RecoveryManaged Care Experience

Required

Five (5) years of management experience
2 years of experience in a Managed Care health plan or state agency
Knowledge of ICD-10 and CPT/HCPC coding guidelines and terminology

Preferred

Eight (8) years of experience in Payment Integrity Audit and Recovery with knowledge of audit strategies such as Data Mining, Clinical Medical Record Review, and Bill Audit Recovery/Program Integrity experience
5 Years of Texas Medicaid, Managed Care Health Plan or State agency experience
Project management or Six Sigma certification

Benefits

Medical
Dental
Vision
Life Insurance
Disability Insurance
Flexible Spending Accounts
And more!

Company

LanceSoft, Inc.

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Established in 2000, LanceSoft is a pioneer in delivering top-notch Global Workforce Solutions and IT Services to a diverse clientele.

H1B Sponsorship

LanceSoft, Inc. has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (55)
2024 (32)
2023 (23)
2022 (25)
2021 (60)
2020 (80)

Funding

Current Stage
Late Stage

Leadership Team

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Ram Karuppusamy
Chairman & CEO
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Simon Dealy
Chief Financial Officer
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Company data provided by crunchbase