• Oversee prepay waste and abuse reviews through coding, editing, and audit programs • Provide guidance and set policies to ensure all programs adhere to state and federal regulations as well as company policies • Oversee prepay editing and retrospective audits to ensure accurate and timely payments of coding and pricing issues • Interpret audit results, develop action plans and present findings to senior management • Develop and implement continuous processes from analytic design to final report stage • Design, develop, and implement internal payment integrity edit and audit programs, policies, and procedures • Monitor laws and regulations that may impact payment integrity policies and procedures and implement changes while maintaining compliance with all state and federal regulations • Recommend process improvement to assist in developing and executing strategic initiatives and goals • Develop and deliver educational training programs to providers and employees to streamline operational processes and ensure accurate coding • Direct and lead Prepay Compliance Managers in their efforts to reduce waste, abuse, and fraud • Performs other duties as assigned • Complies with all policies and standards