Geisinger · 21 hours ago
Senior Director Program Integrity and Special Investigations Unit, Geisinger Health Plan
Danville, PA
Full-time
Onsite
Director/Executive
10+ years expGeisinger is a healthcare organization dedicated to caring for patients and communities. The Senior Director of Program Integrity and Special Investigations Unit is responsible for the strategic direction and oversight of anti-fraud, waste, and abuse prevention efforts, ensuring compliance with regulatory requirements and managing the SIU and PI teams.
HealthcareHospitalHealth CareMedical
Responsibilities
Provides leadership and strategic direction of Special Investigations and Program Integrity units spanning all lines of business
Ensures compliance with all regulators on anti-fraud and program integrity regulations
Presents to executive leadership the Privacy, Compliance and Program Integrity committee to report and communicate areas of non-compliance, risk, financial savings and potential fraud, waste or abuse
Responsible for all PI & SI vendor relationships, including but not limited to, negotiating of contracts, adherence to key terms and ensuring contractual compliance
Leads teams through providing guidance, training, and counseling
Prepares and conducts performance appraisals to ensure team is high functioning and meeting both self and enterprise goals
Monitors workflow and production within the departments and prioritizes work accordingly
Coordinates interview process conducts interviews and initiates candidate selection
Partner with internal stakeholders to support product strategy and sales efforts with PI data
Collaborate with internal departments and maintain a dotted-line relationship with PI functions outside the direct organizational structure, including, but not limited to, Operations
Oversee the configuration, testing and maintenance of the SI and PI software, including upgrades, new release implementation, to ensure proper system set-up and operations for all activity
Oversee all external and internal Fraud, Waste and Abuse and Program Integrity audits
Responsible for Key Performance Indicators including claim edit and claim audit savings, dollars at risk, overpayment recoveries, referrals, as well as department return on Investment
Develops and executes a multi-year PI strategy aligned with financial goals set by the enterprise
Manages budget and financial performance for PI and SI
Qualification
Required
Master's Degree- (Required)
Minimum of 5 years-Managerial/Supervisory (Required)
Minimum of 10 years-Health Insurance/Managed Care (Required)
Preferred
Bachelor's Degree-Business Administration/Healthcare Management (Preferred)
Benefits
We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners.
Company
Geisinger
Geisinger is a health and wellness organization that offers orthopaedic, weight-management, and heart care services. It is a sub-organization of Risant Health.
10001+ employees
Funding
Current Stage
Late StageTotal Funding
$0.95MKey Investors
U.S. Department of Agriculture
2024-04-02Acquired
2024-01-10Grant· $0.95M
Leadership Team
Terry Gilliland
President & CEO
Anne Morse
Director, Division of Pediatric Sleep Medicine
Recent News
EIN Presswire
2025-12-08
2025-11-23
2025-11-03
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