Director, Program Integrity

Lucet

1d•$110,000 - $135,000•Remote

About The Position

The Director of Program Integrity provides strategic direction and oversight of the organizational fraud, waste and abuse (FWA) program encompassing conducting routine and targeted claims audits, data analyses, and investigations to detect, prevent, and remediate FWA related to behavioral health, direct medical care, and other healthcare services. This role is responsible for the oversight of the FWA program through the assurance of accurate medical coding, claims processing, compliance with documentation and regulatory requirements, appropriate service utilization, effective overpayment recovery, and prepayment prevention.

Requirements

Bachelor’s degree in healthcare, public administration, or related field.
3+ years of management experience that clearly demonstrates leadership.
7+ years of experience in healthcare claims auditing, investigations, program integrity, healthcare compliance, or a related area.
7+ year’s healthcare/managed care claims, reimbursement, contracting and/or analytics experience.
Experience in developing and implementing audit and/or anti-fraud plans, policies and procedures, training materials, workflow diagrams, standard operating procedures or other documentation.
Proficient with all healthcare coding (CPT4, HCPCS, DRG, ICD-9, ICD-10 & Revenue Codes)
Experience and familiarity with data analysis and data mining for purposes of fraud detection
Demonstrated experience in successful overpayment recovery.
Ability to pass background check upon hire and throughout employment to include criminal felony & misdemeanor search, SSN validation/trace search (LEIE), education report (highest degree obtained), civil upper and lower search, 7-year employment report, federal criminal search, statewide criminal search, widescreen plus national criminal search, health care sanctions-state med (SAM), national sex offender registry, prohibited parties (OFAC) (terrorist watchlist), and a 10-Panel Drug Screen.
Someone who embodies our values by: Serving everyone with compassion and leading with empathy. Stepping up and creating value by taking charge and acting when there is an opportunity. Adapting in a changing world by recognizing our responsibility to be agile and respond quickly. Nurturing growth and belonging by respecting and celebrating everyone for who they are.
Clearly and professionally conveys complex information in both written and verbal form to internal and external stakeholders.
Analyzes complex information, identifies trends, and draws well-supported conclusions.
Ability to manage sensitive issues with discretion and professionalism.
Builds trust-based and collaborative relationships across teams and with external partners (health plans, regulators).
Adapts quickly to shifting priorities, regulatory changes, or emerging fraud trends.
High-speed internet service (cable or fiber optic) with minimum download Speed of 20 Mbps, Upload Speed of 5 Mbps, and Maximum Latency of 100 milliseconds (must be installed before starting) required.
Frequent use of computer and phone systems
Must be able to constantly remain in a stationary, sitting position, communicate and exchange information with others, inspect information, perform repetitive motions with arms and fingers, interpret data, problem solve, make decisions, organize and plan, and maintain a positive and professional attitude in all situations.
Work is performed from home with company-provided equipment. Sitting for long periods of time is expected and use of fingers and hands for typing is necessary.
A quiet workspace with minimal background noise for calls.

Responsibilities

Strategic Leadership and FWA Oversight: Lead FWA strategy and program integrity efforts through audits, investigations, data analysis, training, and implementation of anti-fraud initiatives that drive compliance and financial recovery. Advise leadership on claims risk, regulatory trends, and recovery opportunities while maintaining strong client relationships and supporting team development and certifications.
Cross-Functional and External Collaboration Partner with internal teams across operations, legal, clinical, IT, and analytics to support audits, committees, and initiatives that strengthen fraud detection and oversight. Serve as the primary liaison to health plans, regulators, law enforcement, and auditors, overseeing external audit responses, regulatory requests, and executive presentations.
Operational Excellence and Innovation Oversee and continuously enhance the FWA Plan, policies, procedures, reporting, and KPIs to ensure accuracy, transparency, and operational effectiveness. Drive innovation by leading training programs, adopting new tools and investigative methods, and managing third-party vendor and partner relationships.
Team Leadership & Development Mentor and lead a high‑performing team by fostering a culture aligned with Lucet’s values, emphasizing accountability, continuous development, and adaptability to change. Provide hands‑on leadership through cross‑functional collaboration, training, and ongoing support to equip team members with best practices, tools, and techniques to achieve shared enterprise‑wide goals.

Benefits

Annual compensation between $110,000 - $135,000, PLUS an annual performance-based, discretionary incentive.
Comprehensive health benefit options: Medical, dental, and vision coverage
401(k) with competitive employer match
Company-paid life and disability insurance
Paid parental leave and wellbeing incentives
Generous paid time off, including volunteer time
Flexible spending accounts for healthcare and dependent care
Professional development opportunities and tuition reimbursement
Remote work flexibility (role-dependent)
Opportunity for meaningful growth, both personally and professionally, where your unique background and experience is welcomed and valued.