Manager Program Integrity - Prepayment Auditing , Geisinger Health Plan

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

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

Requirements

• 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

Preferred Qualifications

• Bachelor's Degree in Nursing, Health Information Management, or Healthcare Administration
• 5+ years of experience in Payment Integrity, Claims Auditing, or Revenue Integrity
• Credentials such as RN, CPC, CCS, or CPMA
• Experience with commercial, Medicare, and Medicaid claim auditing
• Strong understanding of medical coding and clinical validation

Benefits

• Healthcare benefits including vision and dental from day one
• Benefits for domestic partners

About the Company

Geisinger is committed to making better health easier for the more than 1 million people it serves, operating nine hospital campuses, a large health plan, and a medical school.