Remote Program Integrity Analyst II: Healthcare Fraud Investigator

CoventBridge Integrity Systems; Oregon; Hybrid; USD 70,000 - 77,000; Full time

Benefits offered by this job

Medical, Dental, Vision plans

Life, LTD and STD paid by the employer

401(k) with company match up to 4%

Paid Time Off and holidays

Tuition assistance after 1 year

Job summary

CoventBridge Integrity Systems is seeking a Medicaid/Medicare Program Integrity Analyst II to evaluate leads, complaints, and investigations, and to recommend administrative actions. The role reports to the PI Supervisor and can work onsite in Grove City, OH or remotely from a home office.

Responsibilities include reviewing claims data, detecting fraudulent patterns, and developing fraud alerts for CMS and state agencies. Strong research, organization, and communication skills are essential.

Qualifications

• At least 1 year of experience in Program Integrity investigation/detection or a related field.
• Candidates with Certified Fraud Examiner (CFE) certifications will be given priority.
• Knowledge of Medicare/Medicaid policies and regulations is preferred.

Responsibilities

• Perform evaluation and development of leads, complaints, and investigations to determine if further action is warranted
• Conduct reviews for potential fraud or abuse and support investigations
• Analyze Medicare/Medicaid claims data to detect aberrancies and develop leads
• Review claims history and provider files to identify patterns of fraudulent billing
• Prepare fraud alerts and report findings to CMS and state agencies
• Prepare external correspondence and reports including overpayment letters and referrals
• Mentor new PI staff and support the PI Supervisor/Manager

Skills

Research skills

Organization

Time management

Verbal communication

Written communication

Independent work

Multitasking

Statistics knowledge

Data analysis

PC skills

Education

High School Diploma

Criminal Justice

Statistics

Data Analysis

Job description

CoventBridge Integrity Systems is seeking a Medicaid/Medicare Program Integrity Analyst II to evaluate leads, complaints, and investigations, and to recommend administrative actions. The role reports to the PI Supervisor and can work onsite in Grove City, OH or remotely from a home office.

Responsibilities include reviewing claims data, detecting fraudulent patterns, and developing fraud alerts for CMS and state agencies. Strong research, organization, and communication skills are essential.