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Senior Director Program Integrity and Special Investigations Unit, Geisinger Health Plan
Job SummaryResponsible for the strategic direction, planning, oversight, and operation of the Special Investigations ("SI") and Program Integrity ("PI") teams. Develops and directs the prevention, detection and investigation of anti-fraud, waste and abuse (FWA)program processes and oversight and coordination of all program integrity activities. Ensures all regulatory requirements are met including the completion of annual fraud plans and reports. Acts as a point of contact for collaboration with local, state and federal law enforcement and regulatory partners. Provides executive management with reimbursement or recovery recommendations based on PI team’s review of claims for appropriate coding, billed statistics, policies, industry standards and compliance with contractual, state,
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