Director of Program Integrity (Health Plan)

Dallas, TX — Hybrid (Onsite 6 days/month required)

Hourly Range: $61.06 – $96.15

Placement Structure: Permanent, Full-Time

About the Role

A large, mission-driven health plan is seeking a Director of Program Integrity to lead all Payment Integrity and Program Integrity functions. This leader will oversee claims accuracy, FWA (fraud, waste, abuse) prevention, audit strategies, and compliance operations across the plan.

This is a high-impact leadership role supporting organizational performance, regulatory compliance, and cost protection.

What You’ll Do

• Lead the Program Integrity department including claims review, audit strategy, and FWA prevention.
• Improve workflows, processes, and systems to increase accuracy and efficiency.
• Ensure compliance with all state, federal, and accreditation requirements.
• Stay current on Medicaid regulations and audit best practices; apply updates proactively.
• Develop and manage annual budgets, goals, and KPIs.
• Hire, train, coach, and evaluate staff; build a high-performing team culture.
• Drive initiatives that reduce overpayments and prevent improper claims.

Required Experience

• 5+ years of management/leadership experience.
• 8+ years of Payment Integrity Audit & Recovery experience (payer-side).
• 2+ years in a Managed Care health plan or state agency.
• 5+ years of Texas Medicaid, Managed Care, or state agency experience.
• Strong knowledge of:
• Texas Medicaid (STAR, STAR Kids, CHIP)
• NCQA
• UMCC/UMCM
• ICD-10, CPT, HCPCS
• Expertise in:
• Data mining
• Clinical medical record review
• Bill audit recovery
• Payment Integrity oversight
• Payer-side experience is required.
• Provider/hospital revenue recovery only is not eligible.

Skills Needed

• Excellent communication and leadership abilities
• Strong analytical and problem-solving skills
• Ability to manage multiple priorities in a fast-changing environment
• Knowledge of Medicaid regulations and audit methodology
• Proficiency with Microsoft Office

Benefits

• Medical, Dental, Vision
• Life & Disability Insurance
• Flexible Spending Accounts
• Additional employer benefits available