Director of Program Integrity at ALOIS Solutions

Position Title: Director of Program Integrity

Location: Dallas, TX

Position Type: Full-Time | Hybrid (Onsite at least 6 days/month) | Permanent

Compensation: $61.06 – $96.15/hr (Midpoint $82.45/hr) + Full Benefits

Work Schedule: 8:00 AM – 5:00 PM | Monday – Friday

Career Area: Healthcare Administration / Compliance / Medicaid Program Integrity

Position Overview

The Director of Program Integrity provides leadership and oversight for the Program Integrity Department at Parkland Community Health Plan (PCHP), with a strong focus on claims editing, fraud, waste, and abuse (FWA) prevention, and payment accuracy.

This role plays a critical part in ensuring operational excellence, cost containment, and regulatory compliance with state and federal requirements. The Director will also be responsible for leading teams, developing strategic initiatives, and driving performance improvements across program integrity functions.

Key Responsibilities

Operational Leadership

Direct and oversee operations of the Program Integrity Department, ensuring compliance and accuracy in all claims and payment processes.

Identify and analyze job designs, workflows, and processes to enhance efficiency, productivity, and effectiveness across PCHP.

Develop and monitor annual budgets to ensure sufficient funding for departmental goals.

Establish and monitor annual goals and objectives that align with PCHP’s mission and strategic priorities.

Compliance & Regulatory Oversight

Maintain thorough knowledge of applicable federal and state regulations, accreditation standards, and payer requirements.

Develop and enforce internal controls that promote compliance with laws, policies, and contractual obligations.

Stay informed about industry developments, policy updates, and best practices related to Medicaid and managed care.

Team Development & Management

Select, train, motivate, and evaluate departmental staff to ensure optimal performance.

Provide coaching, mentorship, and professional growth opportunities for team members.

Manage performance evaluations, disciplinary actions, and staff development in alignment with organizational policies.

Strategic Planning & Program Development

Lead major initiatives that enhance fraud prevention, payment integrity, and audit recovery outcomes.

Implement strategies for continuous improvement, risk mitigation, and efficiency within program operations.

Utilize data analytics, audit findings, and compliance metrics to inform executive decision-making and policy recommendations.

Skills & Competencies

Strong leadership and communication skills with the ability to influence and build consensus across departments.

Strategic thinker with proven experience in program development and performance improvement.

Demonstrated ability to manage high-level interdisciplinary projects with competing priorities.

Strong analytical and problem-solving skills with sound business acumen.

Expertise in Texas Medicaid programs (STAR, STAR Kids, CHIP), NCQA standards, and Uniform Managed Care Contracts.

Proficient in Microsoft Office and data management tools.

Qualifications

Education & Experience

Bachelor’s degree required; equivalent experience may be considered (8+ years in comparable role).

Five (5) years of management experience – Required.

Eight (8) years of Payment Integrity Audit and Recovery experience – Strongly Preferred.

Experience with Data Mining, Clinical Medical Record Review, and Bill Audit Recovery required.

Two (2) years of Managed Care Health Plan or State Agency experience – Required.

Knowledge of ICD-10 and CPT/HCPC coding guidelines – Required.

Five (5) years of Texas Medicaid, Managed Care Health Plan, or State Agency experience – Required.

Note: Candidates must have payment integrity experience (payer-focused) — not revenue recovery or healthcare system-only experience.

Certifications

Project Management Professional (PMP) or Six Sigma Certification – Strongly Preferred.

Benefits

Medical, Dental, and Vision Insurance

Life and Disability Insurance

Flexible Spending Accounts (FSA)

Employee Assistance Program (EAP)

Additional wellness and retirement benefits

Work Requirements

Must be onsite at least six (6) days per month in Dallas, TX.

Ability to work independently and collaboratively within a hybrid model.