Lead, Prepayment Integrity & Audit Operations

Remotedxb; Dubai; On-site; AED 441,000 - 551,000; Full time

Job summary

Geisinger is seeking a leader to manage the Prepayment Program Integrity function, overseeing claim reviews, vendor edits, and audit strategies to ensure payment accuracy and compliance. The role includes team leadership of nurses, coders, auditors, and analysts, with a focus on regulatory adherence and performance reporting.

The ideal candidate brings extensive experience in prepayment review programs, strong knowledge of reimbursement methodologies, and success in managing external audit

Qualifications

• High School Diploma or equivalent (Required).
• Minimum of 7 years of relevant experience.
• Minimum of 2 years of managerial or supervisory experience.
• Experience managing prepayment review programs and external audit vendors.
• Knowledge of healthcare reimbursement methodologies and claims processing.

Responsibilities

• Manage daily operations of the Prepayment Program Integrity function, including claim reviews and vendor edit oversight
• Develop and implement prepayment auditing strategies to support organizational compliance and payment integrity
• Oversee vendor performance, service delivery, and contractual obligations
• Manage the prepayment audit appeal process and resolve provider disputes
• Lead and develop a team of nurses, coders, auditors, and analysts
• Ensure all auditing activities comply with federal, state, and CMS regulations
• Develop executive-level reporting on audit performance, savings, and vendor effectiveness

Education

High School Diploma or equivalent

Job description

Geisinger is seeking a leader to manage the Prepayment Program Integrity function, overseeing claim reviews, vendor edits, and audit strategies to ensure payment accuracy and compliance. The role includes team leadership of nurses, coders, auditors, and analysts, with a focus on regulatory adherence and performance reporting.

The ideal candidate brings extensive experience in prepayment review programs, strong knowledge of reimbursement methodologies, and success in managing external audit