AVP Program Integrity - Ideation and Analytics
Work@Home USA, United States
USD 167K-250K (estimate) Executive-level Full Time
Tasks
- Build and scale audit operations
- Co create PI roadmaps with clients
- Conduct clinical review audits
- Convert pricing guidelines into automated pricing logic
- Create workflows and SOPs
- Develop audit concepts using data mining
- Develop performance dashboards
- Direct program integrity teams
- Ensure audit accuracy compliance scalability
- Ensure compliance with federal and state regulations
- Govern performance metrics and audit outcomes
- Implement quality assurance programs
- Interpret Medicaid and Medicare reimbursement rules
- Interpret commercial reimbursement rules
- Lead prepay and postpay audit strategy
- Manage PI vendor relationships
- Monitor client KPIs and NPS
- Perform FWA risk assessments
- Provide SIU and FWA oversight
- Support sales and go to market client discussions
- Track medical cost savings ROI and productivity
- Translate medical policy changes into proactive PI strategies
- Translate regulations and payer policies into audit logic
Perks/Benefits
Skills/Tech-stack
Analytics | Audit Methodologies | Audit operations | Automation | Claims Editing | Clinical review | Coding Compliance | Commercial Reimbursement | Contract Audit Methodologies | Data Mining | Fraud Waste and Abuse | KPI Reporting | Medicaid | Medicare | Overpayment Recovery | Payment integrity | Performance dashboards | Postpay Audit | Predictive Analytics | Prepay Audit | Pricer Logic | Pricing logic | Program integrity | Quality Assurance | Regulatory interpretation | Reimbursement Rules | Risk Assessment | SIU | SLA governance | SOP Development | Vendor management | Workflow Optimization
Education
Bachelor of Arts | Bachelor of Engineering | Bachelor of Science
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