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Program Integrity Director Jobs in Louisiana (NOW HIRING)

HGA

Program Director

Baton Rouge, LA · On-site

The Program Director is responsible for the strategic leadership, compliance oversight, and ... Ensure data integrity within grant management and case management systems. • Oversee ...

BHG LXXXIX LLC

Program Director

Houma, LA

Program Director Behavioral Health Group (BHG) is the largest network of Joint Commission ... Join us and become part of a community that values excellence, integrity, and making a real ...

Behavioral Health Group

Program Director

Houma, LA · On-site

Program Director Behavioral Health Group (BHG) is the largest network of Joint Commission ... Join us and become part of a community that values excellence, integrity, and making a real ...

Venture Global LNG

This role reports to the Director, Operations Engineering and will be responsible for assisting the ... This incumbent shall provide support for groundwork support to the overall Asset Management Program ...

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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 Louisiana? For Program Integrity Director jobs in Louisiana, the most frequently searched job titles are:
What job categories do people searching Program Integrity Director jobs in Louisiana look for? The top searched job categories for Program Integrity Director jobs in Louisiana are:
What cities in Louisiana are hiring for Program Integrity Director jobs? Cities in Louisiana with the most Program Integrity Director job openings:
Program Integrity Director jobs near you
Program Integrity - Coordinator 1

Program Integrity - Coordinator 1

University of New Orleans

Baton Rouge, LA

Full-time

Posted 22 days ago

Job description

Thank you for your interest in The University of New Orleans.

Once you start the application process, you will not be able to save your work, so you should collect all required information before you begin. The required information is listed below in the job posting.
You must complete all required portions of the application and attach the required documents in order to be considered for employment.

Department

Program Integrity Operations
Job Summary
Job Description

  • Investigate providers of various Medicaid programs to ensure expenditures are made in accordance with Federal and State regulations.

  • Process and track all Medicaid provider and recipient related complaints reported via email, the Medicaid Fraud website or internally.

  • Interacts with varies internal and external entities such as Medicaid recipients, Medicaid providers, LDH program operations, licensing boards, the Attorney General's office, etc.

  • Document findings of investigations initiated by referrals from Medicaid programs including but not limited to OAAS, Behavioral Health, Provider Enrollment, MFCU and Plans.

  • Detail any corrective action(s) necessary after conducting a comprehensive case review of findings.

  • Ensure all providers are furnished with a written notification of any corrective actions and cite the applicable Medicaid/LaCHIP policy reference.

  • Assist in maintaining records of provider fraud, waste and abuse referrals for investigation.

  • Maintain findings and results on fraud referrals received within the centralized tracking system.

  • Conducts research on all policy violations and corrective action.

  • Maintains and assists with up-to-date reporting statistics and data for unit reports.

  • Notify management of any trends that are a direct cause of or contributing factor to errors that come to light during the review process or while tracking all cases received for review.

  • Refer applicable cases to the Office of the Attorney General.

  • Prepare written summary report with all relevant background facts.

  • Provide any assistance needed to the legal authority.

  • May be called upon as a witness to a case once it proceeds to trial.

  • Complete special projects as directed by management.

QUALIFICATIONS
REQUIRED:

  • Bachelor's Degree, or Associates degree with 3 years professional experience, or 6 years professional experience in lieu of the degree.

  • Excellent analytical skills, effective organizational and time management skills.

  • Excellent verbal and written communications skills.

  • Proficient in the use of Microsoft Office, including but not limited to Outlook, Word, and Excel.

DESIRED:

  • Advanced degree.

  • 2 years professional experience in provider enrollment and credentialing.

  • 1 year professional experience with Louisiana Medicaid policy and procedures.

  • Experience with Electronic Visit Verification.

  • Experience with data analysis and report development.

SALARY: 37-47k

Required Attachments

Please upload the following documents in the Resume/Cover Letter section.

  • Detailed resume listing relevant qualifications and experience;
  • Cover Letter indicating why you are a good fit for the position and University of Louisiana Systems;
  • Names and contact information of three references;

Applications that do not include the required uploaded documents may not be considered.

Posting Close DateThis position will remain open until filled.

Note to Applicant:

Applicants should fully describe their qualifications and experience with specific reference to each of the minimum and preferred qualifications in their cover letter. The search committee will use this information during the initial review of application materials.

References will be contacted at the appropriate phase of the recruitment process.

This position may require a criminal background check to be conducted on the candidate(s) selected for hire.

As part of the hiring process, applicants for positions at the University of New Orleans may be required to demonstrate the ability to perform job-related tasks.

The University of New Orleans is an Affirmative Action and Equal Employment Opportunity employer. We do not discriminate on the basis of race, gender, color, religion, national origin, disability, sexual orientation, gender identity, protected Veteran status, age if 40 or older, or any other characteristic protected by federal, state, or local law.

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