• Oversee a full range of waste, abuse and/or fraud investigations, audits and medical code editing scenarios • Ensure all audits and edits adhere to federal and state Medicaid medical coding and fraud/abuse guidelines • Oversee various functions of the Payment Integrity department for accurate and timely operational reviews and final reviews • Interpret audit results and assist health plan executives in the development of appropriate action plans to address identified risks • Develop and implement continuous editing and auditing processes from analytic design to final report stage • Identify and direct the implementation of new software packages as necessary • Ensure compliance with all state and federal regulations for waste/fraud/abuse and medical coding • Develop corporate policies and procedures and implement corporate initiatives set upper management • Collaborate with Providers, as needed, to train on the payment integrity rules and regulations • Performs other duties as assigned • Complies with all policies and standards