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Program Integrity Director Jobs in Arkansas (NOW HIRING)

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What are the key skills and qualifications needed to thrive as a Program Integrity Director, and why are they important?

To thrive as a Program Integrity Director, you need expertise in compliance, risk management, regulatory analysis, and a relevant degree such as in business administration, public policy, or law. Familiarity with data analytics tools, case management systems, and certifications like Certified Fraud Examiner (CFE) or Certified Internal Auditor (CIA) are often important. Strong leadership, ethical judgment, and effective communication skills are crucial for building trust and guiding teams through complex investigations. These skills ensure the organization maintains regulatory compliance, prevents fraud, and promotes operational transparency.

What are some typical challenges faced by a Program Integrity Director, and how can they be addressed?

Program Integrity Directors often face challenges such as navigating complex regulatory requirements, detecting and preventing fraud, and ensuring compliance across multiple departments or partners. Addressing these requires strong analytical skills, clear communication, and effective collaboration with legal, compliance, and operational teams. Staying updated on industry best practices and fostering a culture of transparency can also help mitigate risks and support program goals.

What are Program Integrity Directors?

Program Integrity Directors are responsible for overseeing and ensuring the compliance, effectiveness, and accountability of organizational programs, often within government agencies or large organizations. They develop and implement policies to prevent fraud, waste, and abuse, and they monitor program operations to ensure adherence to regulations and standards. Program Integrity Directors often lead teams, conduct audits, and collaborate with other departments to promote transparency and ethical practices. Their work is crucial for maintaining public trust and ensuring resources are used appropriately.

What is the difference between Program Integrity Director vs Claims Manager?

AspectProgram Integrity DirectorClaims Manager
Required CredentialsBachelor's degree, certifications in healthcare compliance or auditingBachelor's degree, experience in claims processing or insurance
Work EnvironmentHealthcare or insurance organizations, compliance departmentsInsurance companies, healthcare payers, claims processing units
Employer & Industry UsageUsed in healthcare, government programs, insurance sectorsPrimarily in insurance companies and healthcare payers

The Program Integrity Director focuses on ensuring compliance, preventing fraud, and maintaining program integrity within healthcare or insurance organizations. In contrast, Claims Managers oversee the processing and adjudication of insurance claims. While both roles require knowledge of healthcare or insurance operations, the Program Integrity Director emphasizes compliance and fraud prevention, whereas the Claims Manager concentrates on claims processing efficiency and accuracy.

What job categories do people searching Program Integrity Director jobs in Arkansas look for? The top searched job categories for Program Integrity Director jobs in Arkansas are:
What cities in Arkansas are hiring for Program Integrity Director jobs? Cities in Arkansas with the most Program Integrity Director job openings:
Program Integrity Director jobs near you
Dental Fraud, Waste, and Abuse (FWA) Coordinator

Dental Fraud, Waste, and Abuse (FWA) Coordinator

Delta Dental

Sherwood, AR • On-site

Full-time

Medical, Dental

Posted 10 days ago

Job description

Dental Fraud, Waste, and Abuse (FWA) Coordinator
Job Summary: The Dental Fraud, Waste, and Abuse (FWA) Coordinator is responsible for supporting the identification, prevention, and resolution of fraud, waste, and abuse within the organization's commercial dental plan operations. This role combines investigative, analytical, and compliance functions with a strong focus on data mining and pattern recognition to detect improper billing, coding, and utilization practices. The FWA Coordinator plays a key role in maintaining program integrity, ensuring regulatory compliance, and protecting plan assets. The FWA Coordinator implements priorities and methodologies defined by the Director of Provider Services and Utilization Management and ensures operational alignment with clinical policies established by the Dental Director. The coordinator will monitor operational effectiveness and drive continuous process improvements to support efficiency, compliance, and provider experience.
Primary Job Responsibilities:
  • Utilize data mining and analytics tools to monitor claims data for aberrant patterns, overutilization, and potential fraud indicators specific to commercial dental plans.
  • Investigate suspicious claims and provider activity through thorough chart reviews, data trend analysis, and internal/external research.
  • Collaborate with IT, data analytics, and clinical teams to refine queries, build reports, and improve fraud detection algorithms.
  • Prepare detailed investigative reports and summaries to support internal decision-making and potential enforcement actions.
  • Coordinate with internal departments, including Claims, Legal, Network Management, and Provider Services, to facilitate timely resolution of FWA issues.
  • Assist in development and delivery of provider education initiatives to promote compliant billing practices and reduce unintentional errors.
  • Track and maintain documentation of all FWA cases and associated actions in accordance with regulatory and organizational requirements.
  • Monitor industry trends, regulatory updates, and best practices in dental FWA prevention and detection, especially as they pertain to commercial dental benefits.

Minimum Qualifications:
  • Bachelor's degree in Healthcare Administration, Public Health, Data Analytics, or a related field required. Equivalent experience may be considered.
  • 2-5 years of experience in fraud detection, dental claims analysis, or healthcare compliance within a commercial dental or medical plan.
  • Experience using data mining tools (e.g., SQL, SAS, Excel, Tableau, or similar platforms) to detect and investigate patterns of concern.
  • Familiarity with commercial dental insurance operations and claim workflows.
  • Strong working knowledge of CDT coding, dental billing standards, and provider reimbursement methodologies.
  • Demonstrated ability to analyze large data sets to identify trends and anomalies.
  • Excellent written and verbal communication skills, including ability to prepare concise reports and deliver findings to cross-functional teams.
  • High level of discretion when handling sensitive and confidential information.
  • Ability to work independently and manage multiple projects simultaneously.

Preferred Qualifications:
  • Certified Fraud Examiner (CFE)
  • Certified Dental Coder (CDC)
  • 2-5 years of experience in fraud detection, dental claims analysis, or healthcare compliance within a commercial dental or medical plan.
  • Advanced training or certification in data analytics or health informatics
  • Experience as a registered dental hygienist or other dental clinical experience.
  • Advanced knowledge of dental terminology and procedure codes.
  • Fraud detection and deterrence experience or credentials.
  • Experience in program integrity or compliance roles.

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