Senior Prepayment Integrity Leader

Geisinger; Danville (PA); On-site; USD 120,000 - 180,000; Full time

Job summary

Geisinger is seeking an experienced Prepayment Program Integrity Manager to lead strategic and operational management of prepayment claims auditing programs, vendor edits, and appeals processes. You will oversee a multidisciplinary team and partner with internal stakeholders to optimize claim review performance and cost savings while maintaining regulatory compliance.

Responsibilities include managing day-to-day operations, developing auditing strategies, monitoring performance, and ensuring

Qualifications

• Minimum of 7 years in Payment Integrity, Claims Auditing, or related field.
• 3+ years of managerial or supervisory experience.
• Preferred credentials: RN, CPC, CCS, CPMA, or equivalent.
• Experience managing prepayment review programs and external audit vendors.

Responsibilities

• Manage the daily operations of the Prepayment Program Integrity function and oversee prepayment review activities.
• Develop, implement, and improve prepayment auditing strategies that support payment integrity and compliance.
• Monitor program performance, outcomes, and financial impact to drive improvement.
• Lead vendor performance reviews and ensure alignment with contractual obligations and ethics.
• Oversee audit methodologies, reviews, and coding determinations to meet standards.
• Manage provider appeals, disputes, and engage cross-functional teams for resolution.
• Provide leadership to clinical, coding, auditing, and payment integrity staff.

Skills

Leadership

Payment integrity

Auditing

Regulatory knowledge

Education

High School Diploma

Bachelor's Degree in Nursing, Health Information Management, Healthcare Administration, Business Administration, or related field

Job description

Geisinger is seeking an experienced Prepayment Program Integrity Manager to lead strategic and operational management of prepayment claims auditing programs, vendor edits, and appeals processes. You will oversee a multidisciplinary team and partner with internal stakeholders to optimize claim review performance and cost savings while maintaining regulatory compliance.

Responsibilities include managing day-to-day operations, developing auditing strategies, monitoring performance, and ensuring