Remote Medicaid/Medicare Integrity Analyst II

CoventBridge Integrity; Northern (KY); Hybrid; USD 70,000 - 77,000; Full time

Benefits offered by this job

Medical, Dental, Vision

Life, LTD and STD

401(k) with company match

Paid Time Off and holidays

Tuition assistance after 1 year

Job summary

CoventBridge Integrity Systems seeks a Medicaid/Medicare Program Integrity Analyst II. This remote role evaluates leads, complaints, and investigations to verify fraud allegations and recommends actions, reporting to the Program Integrity Supervisor.

Responsibilities include independent reviews, data analysis of Medicare/Medicaid claims, and preparing fraud alerts for CMS and state agencies, with documentation of investigations and case files.

Qualifications

• High School Diploma or GED; college/technical degree preferred.
• CFE certifications will be given priority.
• At least 1 year of Program Integrity investigation experience.
• Strong research, analytical, and communication skills.

Responsibilities

• Evaluate leads, complaints, and investigations to determine further actions.
• Conduct independent reviews of potential fraud or abuse cases.
• Use data analysis to detect aberrancies in Medicare/Medicaid claims and develop leads.
• Review claims data and provider files to identify fraudulent billing patterns.
• Prepare fraud alerts and share information with CMS and state agencies.
• Maintain documentation for investigations and leads.

Skills

Research skills

Organization

Prioritization

Time management

Verbal communication

Written communication

Independent work

Multitasking

Statistics knowledge

Data analysis

PC skills

Education

High School diploma or GED

Criminal Justice degree preferred

Statistics/Data Analysis degree preferred

Certified Fraud Examiner (CFE) certification

Job description

CoventBridge Integrity Systems seeks a Medicaid/Medicare Program Integrity Analyst II. This remote role evaluates leads, complaints, and investigations to verify fraud allegations and recommends actions, reporting to the Program Integrity Supervisor.

Responsibilities include independent reviews, data analysis of Medicare/Medicaid claims, and preparing fraud alerts for CMS and state agencies, with documentation of investigations and case files.