Job Description

Director of Payment Integrity – Hybrid

Location: Dallas, TX

Compensation: $127,964 – $216,008 annually + bonus

Position Overview

One of the largest public hospital systems in the country is seeking a Director of Program Integrity to lead the Program Integrity department. This role focuses on claims editing, fraud, waste, and abuse (FWA) prevention, and ensuring payment accuracy. The Director will drive operational excellence, cost containment, and adherence to federal and state Medicaid regulations.

Key Responsibilities

• Lead and oversee all Program Integrity operations.
• Design, analyze, and improve workflows to increase productivity and efficiency.
• Stay current with industry developments, regulations, and best practices.
• Develop and implement internal controls ensuring compliance with laws and guidelines.
• Develop and manage department budgets and goals.
• Hire, train, mentor, and evaluate staff.
• Ensure adherence to Texas Medicaid (STAR, STAR Kids/CHIP) and NCQA standards.

Required Skills & Qualifications

• 5+ years management experience.
• 8+ years’ experience in Payment Integrity Audit and Recovery, including data mining, clinical record review, and program integrity audits.
• 2+ years’ experience in a Managed Care health plan or state agency.
• Knowledge of ICD-10 and CPT/HCPCS coding guidelines.
• Strong leadership, strategic thinking, and conflict resolution skills.
• Proficient in Microsoft Office and other relevant systems.
• Certification/Registration/Licensure: Project Management or Six Sigma certification preferred.

Benefits

• Medical, Dental, Vision
• Life & Disability Insurance
• Flexible Spending Accounts
• Additional benefits and leave programs

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