Healthcare Compliance Investigator – Remote

Integra Partners; New Jersey; Remote; USD 90,000 - 130,000; Full time

Benefits offered by this job

Competitive compensation

401(k) match

Life insurance

Short-term disability

Medical, Vision, and Dental

Paid holidays

Remote opportunities

Job summary

Integra Partners is seeking a Compliance Analyst to be an integral member of the Legal team. You will monitor for FWA issues, investigate and audit provider billing and UM auth practices, and support the company’s Corporate Compliance program.

You will collaborate with the Compliance Manager, Payer Division, and cross-functional teams to research providers, review CMS alerts, manage compliance risks, and ensure timely audits of vendors and healthcare providers within the network.

Qualifications

• Bachelor's degree required.
• Minimum three years in Special Investigation Unit or similar.
• Strong understanding of fraud, waste and abuse and HIPAA rules.
• Data analysis experience; Excel proficiency; Tableau a plus.

Responsibilities

• Conduct audits of vendors and healthcare providers for FWA monitoring.
• Run Fraud, Waste, and Abuse investigations.
• Support administration of the Corporate Compliance program.
• Assign and monitor compliance training with auditable records.
• Collaborate with credentialing, QA, and network teams to address concerns.
• Partner with health plan customers on audits and responses.
• Investigate compliance concerns internally and externally.
• Conduct Security Risk Assessments and report to the compliance committee.
• Work with data security staff to address security issues.

Skills

Data analysis

Excel

Tableau

FWA monitoring

Education

Bachelor's degree

Tools

Tableau

Job description

Integra Partners is seeking a Compliance Analyst to be an integral member of the Legal team. You will monitor for FWA issues, investigate and audit provider billing and UM auth practices, and support the company’s Corporate Compliance program.

You will collaborate with the Compliance Manager, Payer Division, and cross-functional teams to research providers, review CMS alerts, manage compliance risks, and ensure timely audits of vendors and healthcare providers within the network.