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Job Summary

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.

Job Duties

• 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.
• Conducts periodic compliance and performance reviews of auditor cases and activity.
• 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.

Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.

*Relevant experience may be a combination of related work experience and degree obtained (Associate’s Degree = 2 years; Bachelor’s Degree = 4 years).

#LI-REMOTE

Education

High School Diploma or Equivalent (GED)- (Required)

Experience

Minimum of 2 years-Managerial/Supervisory (Required), Minimum of 7 years-Relevant experience* (Required)

Skills

Fraud Detection And Prevention; Communication; Analytical Thinking; Critical Thinking; Computer Coding; Insurance Industry; Fraud Management; Leadership

About Geisinger

Founded more than 100 years ago by Abigail Geisinger, the system now includes ten hospital campuses, a 550,000-member health plan, two research centers and the Geisinger Commonwealth School of Medicine. With nearly 24,000 employees and more than 1,700 employed physicians, Geisinger boosts its hometown economies in Pennsylvania by billions of dollars annually. Learn more at geisinger.org or connect with us on Facebook, Instagram, LinkedIn and Twitter.

Equal Opportunity Employer

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, status as a protected veteran, or any other protected category under applicable federal, state, and local laws.

Our Vision & Values

Everything we do is about making better health easier for our patients, our members, our students, our Geisinger family and our communities.

KINDNESS: We strive to treat everyone as we would hope to be treated ourselves.

EXCELLENCE: We treasure colleagues who humbly strive for excellence.

LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow.

INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation.

SAFETY: We provide a safe environment for our patients and members and the Geisinger family.

Our Benefits

We offer healthcare benefits for full time and part time positions from day one, including vision, dental and prescription coverage.