The Program Integrity Manager is responsible for administering innovative fraud, waste, and abuse detection solutions for Medicaid & Medicare payers. This position will guide Medicaid and Medicare health care fraud detection efforts within the health plan. The individual will identify vulnerabilities within VPHP and payment vulnerabilities with providers. This position will develop policy & procedures and lead the data mining efforts to detect fraud, waste and abuse. The PI Manager will work closely with the Director of Program Integrity and the VP of Network Development to develop education and a recoupment methodology based on findings of audit activities that are designed to reduce or eliminate provider billing irregularities.
MINIMUM EDUCATION REQUIREMENTS
SPECIAL KNOWLEDGE AND/OR SKILLS
Virginia Premier is a managed care organization which began as a full-service Medicaid MCO in 1995. Partnered with VCU Medical Systems we strive to meet the needs of the underserved and vulnerable populations in Virginia by delivering quality driven, culturally sensitive and financially viable Medicare and Medicaid healthcare programs. Headquartered in Richmond, VA we also have offices in Roanoke, Tidewater and Bristol with additional satellite locations allowing us to serve over 200,000 members across eighty counties throughout Virginia.
We offer competitive salaries and a comprehensive benefits package to include excellent Medical, Dental and Vision Plans, Tuition Assistance, Infant-At-Work Program, Remote Work options and generous vacation and sick leave policies. Our culture supports an environment where employees can continuously learn and gain professional growth through various development programs, education, exciting projects and career mobility.
All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE
Our mission is to inspire healthy living within the communities we serve!