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Program Integrity Director Jobs in Nevada (NOW HIRING)

Renown Health

Director of Revenue Integrity

Reno, NV · On-site

$71.51 - $100.11/hr

The Director of Revenue Integrity will be charged with ensuring the integrity of the revenue across ... Makes recommendations to the Vice President of Revenue Cycle regarding programs, projects, or ...

Renown Health

Director of Revenue Integrity

Reno, NV · Remote

The Director of Revenue Integrity will be charged with ensuring the integrity of the revenue across ... Makes recommendations to the Vice President of Revenue Cycle regarding programs, projects, or ...

Renown Health

Director of Revenue Integrity

Reno, NV · Remote

The Director of Revenue Integrity will be charged with ensuring the integrity of the revenue across ... Makes recommendations to the Vice President of Revenue Cycle regarding programs, projects, or ...

Boys & Girls Clubs of Southern Nevada

$52K/yr

The Program Director is also responsible for related administrative tasks. The essential job duties ... Ensures programming schedule accountability, proper attendance recording and integrity, and data ...

Yerington Paiute Tribe

Executive Director

Yerington, NV · On-site

$40.32 - $42.77/hr

The Executive Director ensures effective program delivery, fiscal accountability, regulatory ... ensure program integrity and accountability. * Develops, implements, and enforces Housing ...

Tancell Care

BCBA Consultant

Las Vegas, NV · On-site

$67K - $82K/yr

... program development, systems building, and mentoring leadership teams, rather than ongoing direct ... integrity. Key Responsibilities Program & Licensing Development * Guide the organization through ...

Valid8 Financial, Inc.

Medical Director

Las Vegas, NV · On-site

Partner with DRG Integrity Specialists to confirm principal diagnoses, procedures, and DRG ... Completion of an ACGME-accredited residency program preferred. * Experience: * Minimum of 5 years ...

Valid8 Financial, Inc.

Medical Director

Las Vegas, NV · Remote

Partner with DRG Integrity Specialists to confirm principal diagnoses, procedures, and DRG ... Completion of an ACGME-accredited residency program preferred. * Experience: * Minimum of 5 years ...

SNC-Lavalin

Program Manager

Henderson, NV · On-site

$175K - $200K/yr

Rewards & benefits At Atkins Realis, our values-Safety, Integrity, Collaboration, Innovation, and ... Note to staffing and direct hire agencies: In the event a recruiter or agency who is not on our ...

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

Director of Revenue Integrity

Renown Health

Reno, NV • On-site

$71.51 - $100.11/hr

Full-time

Posted 20 days ago

Renown Health rating

7.5

Company rating: 7.5 out of 10

Based on 97 frontline employees who took The Breakroom Quiz

231st of 882 rated healthcare providers

Job description

Position Purpose:
The Director of Revenue Integrity will be charged with ensuring the integrity of the revenue across all entities of the health network. This will be accomplished through review and assurance of accurate charging, strategic price setting, use of robust denial avoidance techniques, and oversight of a training team to suppport best-in-class, patient focused revenue cycle operations with a metric-driven, performance-based culture of accountability at all levels.
Nature and Scope:
The Director of Revenue Integrity will make recommendations for improvements and initiatives to support optimal revenue capture for the organization. The director will provide coordination and subject matter expertise across their areas of responsibility and will act as a liaison between the Revenue Cycle and other departments across the organization in developing streamlined, cost-effective, patient-centric operations that support the integrity of our current and future revenue streams. In addition, the director will have direct responsibility to plan, organize and implement process and business improvements on designated strategic initiatives. The director will collaborate with inter-departmental teams to effect change that is cohesive and embraced by the participants for optimal outcomes.
Additional responsibilities include:
• Track and benchmark revenue integrity metrics for all departments while coordinating standard usage of all system reporting.
• Ensure optimization of the Epic System.
• Plan and implement regular reviews as directed by the Vice President of Revenue Cycle.
• Lead and direct the Revenue Cycle training teams to support all revenue cycle training needs and system wide training as necessary.
• Provide for effective chart audit policy with action plans and measurable outcomes.
  • Ensure compliant charging through consistent review of chargemaster services and codes throughout the health network service lines.
  • Manage RAC processes and workflows throughout the health network.
  • Establishes denial avoidance feedback loops and improves operational processes to enhance revenue capture.
  • Develops and makes recommendations in the creation of capital and operating budgets.
  • Develops and strengthens relationships with medical staff and medical center entities.
  • Makes recommendations to the Vice President of Revenue Cycle regarding programs, projects, or procedures that may improve efficiency, increase cash collections, reduce bad debt, motivate staff, or in general benefit the Revenue Cycle departments.
  • Identifies and implements Transformational Healthcare projects to implement change rapidly and effectively.
  • Ensures standard work is documented and implemented.
  • Establishes effective communication with all departments impacting revenue including HIM, Information Systems departments, and revenue producing departments to ensure cohesive process among all areas impacting Revenue Cycle.
  • Monitors and implements initiatives to improve patient experience and first impression scores.

This position does not provide patient care.
The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.
Minimum Qualifications: Requirements - Required and/or Preferred
Education:
Must have college-level knowledge of the English language, including reading, writing and speaking English. Bachelor's degree required. Successful experience in a similar role may be substituted for Bachelors. Masters degree in business, accounting or finance with a Healthcare concentration preferred.
Experience:
Five + years experience directly/indirectly managing a minimum of 75+ FTEs across multiple departments and knowledge with developing and managing large operating budgets. Five years of experience using PC spreadsheet applications.
License(s):
None
Certification(s):
HFMA certification preferred, but not required.
Computer / Typing:
Must be proficient with Microsoft Office Suite, including Outlook, PowerPoint, Excel and Word and have the ability to use the computer to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.

What Renown Health employees say

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About Renown Health

Sourced by ZipRecruiter

Renown Health is a leading and respected player in the healthcare industry, based in Reno, NV, US. Established in 1862, the company has a deep-rooted history in providing high-quality healthcare services to the community. Renown Health offers a wide array of services including urgent care centers, lab services, x-ray and imaging services, primary care doctors and specialists. Its central values include excellence in quality and service, caring for people first, being proactive in the community, fiscal responsibility, integrity, and respecting every person.

Industry

Health care and social assistance

Company size

5,001 - 10,000 Employees

Headquarters location

Reno, NV, US

Year founded

1862

Social media

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