Project Regulatory Specialist

Integra Partners; Elm (PA); Remote; USD 65,000 - 90,000; Full time

Benefits offered by this job

Annual bonus

401(k) with company match

Company-paid life insurance

Short-term disability

Medical, Vision, and Dental benefits

Paid holidays and floating holidays

Remote opportunities

Job summary

Integra Partners is seeking a Compliance Analyst to join the Legal team in the United States. You will monitor for FWA issues, audit provider billing, and support the company’s corporate compliance program across the DMEPOS network.

You’ll collaborate with Compliance Manager, Payer Division, credentialing, quality assurance, and network management to address concerns, conduct audits, and ensure adherence to Medicare/Medicaid guidelines. Bachelor's degree and 3+ years in SIU required.

Qualifications

• Bachelor’s degree required; 3+ years in SIU or similar role.
• Strong knowledge of fraud, waste and abuse in healthcare.
• Experience with medical billing and credentialing.
• HIPAA compliance understanding.
• Proficient data analysis; Excel; Tableau experience.

Responsibilities

• Audit vendors and providers for FWA monitoring.
• Run Fraud, Waste and Abuse investigations.
• Support Corporate Compliance program administration.
• Assign and monitor compliance training; maintain records.
• Collaborate with credentialing, QA, network teams.
• Partner with health plan customers on audits.
• Investigate internal and external compliance concerns.
• Conduct Security Risk Assessments and report to compliance committee.
• Coordinate with data security staff on issues.

Skills

SIU processes

Fraud & abuse

HIPAA knowledge

Data analysis

Excel

Tableau

Education

Bachelor's degree

Tools

Tableau

Job description

The Legal team at Integra Partners works cross-functionally to help achieve our mission of reducing friction in healthcare. We are committed to working collaboratively, transparently, and efficiently to provide exceptional legal and compliance services to our internal stakeholders, health plans, and providers. We are committed to excellence in our work, a growth mindset and continuous improvement, and cultivating a deep understanding of the healthcare industry.

We are hiring a Compliance Analyst to be an integral member of the Legal team and ensure we meet and exceed all our compliance obligations. In this role, you will bring your previous compliance experience and knowledge to monitor for FWA issues and investigate and audit provider billing and UM auth request practices. Some of your key responsibilities will be researching providers, reviewing CMS alerts, as well as keeping up-to-date and managing compliance risks that impact our business and the DMEPOS industry. You will work closely with our Compliance Manager, Payer Division and partner with individuals at all levels of the company. The Compliance Analyst’s responsibilities include but are not limited to:

• The primary focus of this role will be to conduct audits of vendors and healthcare providers in support of our FWA monitoring processes
• Run the Fraud, Waste, and Abuse investigation processes
• Support the administration of the company’s Corporate Compliance program
• Assign and monitor compliance training and keep detailed, auditable records
• Collaborate with our credentialing, quality assurance, and network management teams to address any concerns and implement change as needed
• Partner with health plan customers on audits of our business, draft and track audit processes and responses
• Investigate compliance concerns and issues internally and externally
• Conduct Security Risk Assessments and present results to the compliance committee.
• Work closely with our data security staff to address security issues that arise
• Reports to our Compliance Manager, Payer Division

Within the first month, you will learn about Integra’s business, our policies and procedures, learn how Medicare and Medicaid guidelines impact our business, how we run our compliance programs, and be introduced to the teams with which you will partner cross-functionally.

Within your first 90 days working with the company, you will initiate audits of providers in our network, research current FWA events and respond to plan questions.

We expect that within six months you will have a strong grasp of the rules and regulations which govern our business. You will take ownership of audits and partner with teams on assigned compliance or security concerns. We expect that you’ll also be able to recommend ways in which we can improve our processes, procedures, and making sure we’re up to date with regulatory changes impacting the business.

Bachelor’s degree

At least three years’ experience in Special Investigation Unit processes or similar roles; Strong understanding of fraud waste and abuse issues, healthcare credentialing, medical billing, HIPAA, and related legislation

Experience with data analysis and excellent user of Excel. Experience with Tableau a plus.

Working knowledge of medical billing processes

Excellent organizational skills, ability to manage multiple projects at once, follow through, and meet tight deadlines.

A commitment to provide high quality client service and a strong desire to build trusted advisor relationships with key clients and executives.

Ability to manage and handle sensitive and confidential information with the highest levels of integrity, ethical standards, discretion, and sound judgment.

• Competitive compensation and annual bonus program
• ~401(k) retirement program with company match
• ~ Company-paid life insurance
• ~ Company-paid short term disability coverage (location restrictions may apply)
• ~ Medical, Vision, and Dental benefits
• ~ Paid company holidays and floating holidays
• ~ Remote Opportunities

Founded in 2005, Integra Partners is a leading national durable medical equipment, prosthetic, and orthotic supplies (DMEPOS) network administrator. Our mission is to improve the quality of life for the communities we serve by reimagining access to in-home healthcare. We connect Payers, Providers, and Members through innovative technology and streamlined workflows affording Members access to top local Providers and culturally competent care. By focusing on transparency, accountability, and adaptability, we help deliver better health outcomes and more efficient management of complex healthcare benefits.

With a location in Michigan plus a remote workforce across the United States, Integra has a culture focused on collaboration, teamwork, and our values: One Team, Drive Results, Push the Boundaries, Value Others, and Build Community. If you are a person with a disability and require assistance during the application process, please don’t hesitate to reach out.