Remote Senior Program Integrity Lead – Healthcare Audits

Geisinger; United States; Remote; USD 120,000 - 170,000; Full time

Job summary

Geisinger is seeking a Program Integrity leader to manage day-to-day operations, ensuring compliance with federal and state regulations while maintaining audit data integrity.

The role oversees prepayment claim review, vendor edits, and performance metrics to drive continuous improvement and cost savings. You will guide audits, clinical review standards, and payment integrity initiatives across multiple teams.

Qualifications

• 5+ years of experience in Payment Integrity, Claims Auditing, Healthcare Compliance, SIU, Program Integrity, or Revenue Integrity.

Responsibilities

• Oversee daily operations of the Prepayment Program Integrity function, including prepayment claim review and vendor edit oversight.
• Develop, implement, and continuously improve prepayment auditing strategies that support organizational payment integrity and compliance objectives.
• Monitor program performance, audit outcomes, operational metrics, and financial impact to drive continuous improvement.
• Establish and maintain policies, procedures, workflows, and controls related to prepayment claims auditing activities.
• Prioritize and manage multiple initiatives while meeting regulatory requirements, business objectives, and operational deadlines.

Skills

Leadership

Auditing

Vendor management

Process improvement

Regulatory knowledge

Education

Bachelor's degree in Nursing

Job description

Geisinger is seeking a Program Integrity leader to manage day-to-day operations, ensuring compliance with federal and state regulations while maintaining audit data integrity.

The role oversees prepayment claim review, vendor edits, and performance metrics to drive continuous improvement and cost savings. You will guide audits, clinical review standards, and payment integrity initiatives across multiple teams.