Project Regulatory Specialist

Integra Partners; South Carolina; Remote; USD 65,000 - 95,000; Full time

Benefits offered by this job

401(k) match

Life insurance

Short-term disability

Health, Vision, and Dental

Paid holidays

Remote opportunities

Annual bonus

Job summary

Integra Partners is seeking a Compliance Analyst to join our Legal team and strengthen our FWA monitoring, auditing, and compliance programs. You will audit providers, investigate FWA events, and collaborate with multiple teams to manage regulatory risk across the DMEPOS space.

You will contribute to training programs, maintain auditable records, and work with health plans on audits and responses while aligning with Medicare/Medicaid guidelines and company policies.

Qualifications

• Bachelor’s degree required and relevant experience in investigations.
• Minimum three years in Special Investigation Unit processes or similar roles.
• Strong understanding of fraud, waste and abuse in healthcare, credentialing, billing, HIPAA.
• Experience with data analysis and strong Excel skills. Tableau a plus.
• Knowledge of medical billing processes and related regulations.
• Excellent organizational skills and ability to manage multiple projects.
• Commitment to high quality client service and trusted advisor relationships.

Responsibilities

• Conduct audits of vendors and providers in support of FWA monitoring.
• Run Fraud, Waste, and Abuse investigation processes.
• Support administration of Corporate Compliance program.
• Assign and monitor compliance training and maintain auditable records.
• Collaborate with credentialing, QA, and network teams to address concerns.
• Partner with health plan customers on audits and responses.
• Investigate compliance issues internally and externally.
• Conduct Security Risk Assessments and present results.

Skills

FWA monitoring

Audits

Data analysis

Excel proficiency

Tableau experience

HIPAA knowledge

Education

Bachelor’s degree

Tools

Excel

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.