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Program Integrity Director Jobs in Reston, VA (NOW HIRING)

NRECA

Director Safety Programs

Arlington, VA · On-site

$176K - $216K/yr

As a "best place to work" employer, we operate with integrity, transparency and a spirit of ... Serves as the NRECA liaison to Federated Rural Electric Insurance Exchange for program development ...

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Program Integrity Director information

See Reston, VA salary details

$30.7K

$81.4K

$142.5K

How much do program integrity director jobs pay per year?

As of Aug 22, 2026, the average yearly pay for program integrity director in Reston, VA is $81,351.00, according to ZipRecruiter salary data. Most workers in this role earn between $55,100.00 and $96,200.00 per year, depending on experience, location, and employer.

What is a program integrity director?

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 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 popular job titles related to Program Integrity Director jobs in Reston, VA?

For Program Integrity Director jobs in Reston, VA, the most frequently searched job titles are:

What job categories do people searching Program Integrity Director jobs in Reston, VA look for?

The top searched job categories for Program Integrity Director jobs in Reston, VA are:

What cities near Reston, VA are hiring for Program Integrity Director jobs?

Cities near Reston, VA with the most Program Integrity Director job openings:

Program Integrity Director jobs near you

Compliance Audit / Investigator / Coder - CCS / CPC / or CCA

MedStar Health

Washington, DC • On-site

Full-time

Re-posted 5 days ago

Medstar Health rating

7.8

Company rating: 7.8 out of 10

Based on 240 frontline employees who took The Breakroom Quiz

128th of 891 rated healthcare providers

Job description

About the Job
General Summary of Position
Assists in the MedStar Family Choice compliance program related to program integrity. Conducts provider audits to identify and address improper billing practices. We recruit, retain, and advance associates with diverse backgrounds skills and talents equitably at all levels.
Primary Duties and Responsibilities
  • Analyzes current payment policies and makes recommendations to improve program integrity and organizational processes.
  • Assists with and tracks responses to external government inquiries investigations data requests subpoenas and fair hearings. Responds to government requests for claims data/information.
  • Prepares written audit reports and communicates the results to management. Initiates corrective action plans or continuous improvement plans identified through audits.
  • Communicates compliance issues and findings identified through audits and reviews. Prepares written audit reports and communicates the results to management. Initiates corrective action plans or continuous improvement plans identified through audits.
  • Coordinates monthly exclusion data base checks review and report findings.
  • Completes assigned routine and selected audits all within assigned time frames. Ensures timely completion of risk assessments and related activities. Maintains or exceeds designated quality and production goals.
  • Utilizes established process to track audits and follow-up claim reviews data requests including fraud analytics software audit case management system.
  • Maintains confidentiality of all provider and member sensitive information reviewed during the auditing process.
  • Participates in health plan and business unit meetings and serves on system wide committees as appropriate. Serves as a technical resource in researching and responding to compliance inquiries.
  • Participates in multidisciplinary quality and service improvement teams as appropriate. Participates in meetings serves on committees and represents the department and hospital/facility in community outreach efforts as appropriate.
  • Performs routine and selected audits of member and employee data for possible fraud waste and abuse. Utilizes audit and monitoring tools to analyze and trend data to identify variances in claims billing in order to detect potential compliance issues.
  • Performs concurrent and retrospective coding and documentation or clinical review audits of respective plan service areas including Behavioral Health services and other duties as assigned to detect potential compliance and/or fraud waste and abuse.
  • Reports any inquiries concerning improper billing practices or reports of non-compliance to the Director of Medicaid Contract Oversight.
  • Conducts telephonic member interviews as needed to verify services were received or to assist in other investigations.
  • Analyzes and reports on claims data through a working knowledge of ICD-10 HCPCS and CPT coding guidelines state and federal regulations and various regulatory agency standards to identify trend and potential fraud waste and abuse.
  • Conducts provider coding and documentation audits for specific provider types including behavioral health for MFC DC depending upon the health plan that this role supports (MFC MD or MFC DC).

Minimal Qualifications
Education
  • High School Diploma or GED required
  • Bachelor's degree preferred

Experience
  • 4 years related experience required

Licenses and Certifications
  • CCS-Certified Coding Specialist At least one coding credential required: Certified Coding Specialist (CCS), Certified Coding Associate (CCA), or Certified Professional Coder (CPC) required

Knowledge Skills and Abilities
  • Must possess excellent organizational skills including the ability to prioritize multiple tasks and perform them accurately and simultaneously.
  • Ability to work with minimal supervision, guidance, and direction.
  • Must be proficient with MS Office (Word, Excel, PowerPoint, and Outlook).
  • Proficient knowledge of Medicaid, Medicare, and other third party payer requirements pertaining to documentation, coding, billing, and reimbursement.
  • Proficient with performing coding and documentation reviews.
  • Strong working knowledge of health care and provide billing regulations related to payer reimbursement policies and CPT/HCPCS coding guidelines.
  • Excellent verbal and written communication skills.
  • Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
  • Ability to establish and maintain positive and effective work relationships with members providers vendors and co-workers
  • Demonstrated knowledge of and skill in data collection analysis and/or interpretation of provider claims data.
  • Prior coding and documentation auditing experience is required in a provider or insurance environment.
  • Auditing experience with specialized provider types such as behavioral health is preferred as identified by the health plan (MFC DC or MFC MD) that this role supports.

This position has a hiring range of
USD $65,062.00 - USD $117,291.00 /Yr.

What Medstar Health employees say

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About Medstar Health

Sourced by ZipRecruiter

MedStar Health is dedicated to providing the highest quality care for people in Maryland and the Washington, D.C., region, while advancing the practice of medicine through education, innovation, and research. Our team of 32,000 includes physicians, nurses, residents, fellows, and many other clinical and non-clinical associates working in a variety of settings across our health system, including 10 hospitals and more than 300 community-based locations, the largest home health provider in the region, and highly respected institutes dedicated to research and innovation. As the medical education and clinical partner of Georgetown University for more than 20 years, MedStar Health is dedicated not only to teaching the next generation of doctors, but also to the continuing education, professional development, and personal fulfillment of our whole team. Together, we use the best of our minds and the best of our hearts to serve our patients, those who care for them, and our communities. It's how we treat people.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Columbia, MD, US

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