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Program Integrity Director Jobs in Texas (NOW HIRING)

Securitas

Senior Program Director

Houston, TX · On-site

$145K - $150K/yr

Global Clients Senior Program Director Location: Houston, Texas Compensation: Base salary range ... Our core values - Integrity, Vigilance and Helpfulness - are represented by the three red dots in ...

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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.
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Program Integrity Director jobs near you
Dir. Charge Capture Integrity

Dir. Charge Capture Integrity

University Medical Center of El Paso

El Paso, TX • On-site

Full-time

Re-posted 12 days ago

University Medical Center Of El Paso rating

6.7

Company rating: 6.7 out of 10

Based on 36 frontline employees who took The Breakroom Quiz

612th of 1,012 rated hospitals

Job description

Job Description:

The Director of Charge Capture Integrity oversees the implementation and coordination of the department to include clinical, financial, quality, program planning, monitoring and maintenance. Oversees implementation of processes and systematically monitors, analyzes and contributes to the improvement of the revenue cycle. Directs improvement opportunities by prioritation based on occurrences and expected impact. Added responsibilities include oversight of productivity, operational effectiveness through benchmarking, maintenance of the charge description master, and development of cube and crystal report for canned and Adhoc reporting.

 

Required Skills:


  1. Communicates effectively both orally and in writing.

  2. Able to evaluate Care Management issues and present data to other professionals, including physicians, in a clear concise manner.

  3. Understands, utilizes and teaches the fundamentals of continuous quality improvement.

  4. Proficient in the principals of analytical assessment and creative problem solving.

  5. Has knowledge of hospital systems and organizational relationships.

  6. Proven experience prioritizing organizational performance improvement efforts.

  7. Works effectively in teams or alone.

  8. Experienced in group facilitation techniques.

 

Required Experience:

Work Experience:

 

High familiarity with all aspects of the revenue cycle, including but not limited to: admissions, registration, insurance verification, denials, charge capture, claims management, charge master compliance, auditing, Electronic Health Record, productivity systems, benchmarking systems. Must be familiar with and have knowledge of hospital structures and functions.

 

Five years management experience required.

  

License/Registration/Certification:

 

None

  

Education and Training:

 

Bachelor’s degree in related field required. Master’s degree preferred.

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