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Program Integrity Director Jobs in Colorado (NOW HIRING)

BHG LXXXIX LLC

Program Director

Fort Collins, CO

The Program Director supervises daily operations of an opiate treatment center, ensuring excellence ... Join us and become part of a community that values excellence, integrity, and making a real ...

Behavioral Health Group

Program Director

Fort Collins, CO · On-site

$80K - $90K/yr

The Program Director supervises daily operations of an opiate treatment center, ensuring excellence ... Join us and become part of a community that values excellence, integrity, and making a real ...

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Program Integrity Director information

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 are popular job titles related to Program Integrity Director jobs in Colorado? For Program Integrity Director jobs in Colorado, the most frequently searched job titles are:
What job categories do people searching Program Integrity Director jobs in Colorado look for? The top searched job categories for Program Integrity Director jobs in Colorado are:
What cities in Colorado are hiring for Program Integrity Director jobs? Cities in Colorado with the most Program Integrity Director job openings:
Program Integrity Director jobs near you
Health Insurance Specialist

Health Insurance Specialist

Centers for Medicare & Medicaid Services

Denver, CO • On-site, Remote

$118.68K - $154.28K/yr

Full-time

Posted 9 days ago

Job description

Summary
This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Program Integrity.
As a Health Insurance Specialist, GS-0107-13, you will serve in the Executive Support Group (ESG), protecting program integrity through rigorous FWA detection, analysis, and oversight.
Learn more about this agency
Duties
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  • Leading development, evaluation, and implementation of program integrity policies and initiatives supporting CMS programs and providers.
  • Reviewing financial program payments, investigate fraud waste and abuse allegations, and conduct program integrity reviews to identify vulnerabilities.
  • Overseeing administrative studies and projects to monitor and address program vulnerabilities and recommend solutions and corrective actions.
  • Analyzing and update operating policies and procedures for program integrity, applying statutes regulations and guidance to propose improvements.
  • Coordinate cross-functional efforts to develop best practices or program integrity guidance.

Requirements
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Conditions of employment
  • You must be a U.S. Citizen or National to apply for this position.
  • You will be subject to a background and suitability investigation.
  • Time-in-Grade restrictions apply.
  • Selective Service: Males born after December 31, 1959, must be registered or exempt from Selective Service - http://www.sss.gov
  • One-year probationary period may be required
  • If you are selected for this position, the documentation that you present for purposes of completing the Department of Homeland Security (DHS) Form I-9 will be verified through the DHS "E-Verify" System
  • All Federal employees are required to have Federal salary payments made by direct deposit to a financial institution of their choice

Qualifications
ALL QUALIFICATION REQUIREMENTS MUST BE MET WITHIN 30 DAYS OF THE CLOSING DATE OF THIS ANNOUNCEMENT.
Your resume (limited to no more than 2 pages) must include detailed information as it relates to the responsibilities and specialized experience for this position. Evidence of copying and pasting directly from the vacancy announcement without clearly documenting supplemental information to describe your experience will result in an ineligible rating. This will prevent you from being considered further.
In order to qualify for the GS-13, you must meet the following: You must demonstrate in your resume at least one year (52 weeks) of qualifying specialized experience equivalent to the GS-12 grade level in the Federal government, obtained in either the private or public sector, to include:
1.Evaluating health insurance program vulnerabilities to detect fraud, waste, or abuse;
2.Collaborating across organizational lines on investigations, audits, or oversight of health insurance programs; and
3.Proposing policy changes relating to program integrity.
Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional, philanthropic, religious, spiritual, community, student, social). Volunteer work helps build critical competencies, knowledge, and skills, and can provide valuable training and experience that translates directly to paid employment. You will receive credit for all qualifying experience, including volunteer experience.
Time-in-Grade: To be eligible, current Federal employees must have served at least 52 weeks (one year) at the next lower grade level from the position/grade level(s) to which they are applying.
Click the following link to view the occupational questionnaire: https://apply.usastaffing.gov/ViewQuestionnaire/12968705
Education
This job does not have an education qualification requirement.
Additional information
Bargaining Unit Position: Yes
Tour of Duty: Flexible
Recruitment Incentive: Not Authorized
Relocation Incentive: Not Authorized
Financial Disclosure: Not Required
Workplace Flexibility at CMS: This position has a regular and recurring reporting requirement to the CMS office listed in this announcement. CMS offers flexible working arrangements and allows employees the opportunity to participate in alternative work schedules at the manager's discretion.
The Interagency Career Transition Assistance Plan (ICTAP) and Career Transition Assistance Plan (CTAP) provide eligible displaced federal employees with selection priority over other candidates for competitive service vacancies. To be qualified you must submit the required documentation and be rated well-qualified for this vacancy. Click here for a detailed description of the required supporting documents. A well-qualified applicant is one whose knowledge, skills and abilities clearly exceed the minimum qualification requirements of the position. Additional information about ICTAP and CTAP eligibility is on OPM's Career Transition Resources website at www.opm.gov/rif/employee_guides/career_transition.asp.
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Candidates should be committed to improving the efficiency of the Federal government, passionate about the ideals of our American republic, and committed to upholding the rule of law and the United States Constitution.
Benefits
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A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Opens in a new windowLearn more about federal benefits.
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Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time or intermittent. Contact the hiring agency for more information on the specific benefits offered.

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