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Sr. Program Integrity Analyst

2 hours, 11 minutes ago
United States
Full-time
Senior
Business Analyst
Data Science and Analytics
Machine Learning Python R
Apply Now
HHAeXchange

HHAeXchange

HHAeXchange is a premier homecare management software connecting providers, payers, and caregivers for proactive care, efficiency, and transparency in the industry.

Health Care Providers & Services
251-1K
Founded 2008
View All Jobs 14

Description

  • Analyze Medicaid claims, visit, and EVV data to identify fraud, waste, and abuse patterns and anomalies.
  • Distinguish fraud, waste, and abuse cases and recommend appropriate investigative or corrective actions.
  • Conduct proactive analyses to surface emerging program integrity risks and trends.
  • Translate analytical findings into business requirements for product and engineering teams.
  • Contribute to the design of fraud detection dashboards, alerting systems, and investigation workflows.
  • Validate detection tools and models for false positives, coverage gaps, and missed risk categories.
  • Serve as a subject matter expert on program integrity and fraud detection concepts.
  • Present findings and program integrity insights to state agencies, managed care organizations, and internal stakeholders.
  • Support customers with regulatory reporting, corrective action priorities, audit readiness, and program integrity outcomes.
  • Document methodologies and investigation approaches for compliance reviews, audits, and reporting.

Requirements

  • Bachelor’s degree and 5+ years of experience in healthcare fraud detection, program integrity, payment integrity, SIU investigation, or a related field.
  • Working knowledge of Medicaid operations, including provider enrollment, service documentation, claims submission, and reimbursement.
  • Demonstrated ability to recognize fraud, waste, and abuse patterns in healthcare claims or billing data.
  • Strong analytical thinking and investigative problem-solving skills.
  • Ability to communicate complex findings to technical and non-technical audiences.
  • Comfort working with ambiguous or fragmented data architecture across multiple systems and tables.
  • Ability to work independently in an evolving environment and proactively identify needed resources and stakeholders.
  • Working familiarity with data tools sufficient to query, explore, and validate analytical outputs independently.
  • Willingness to explore and adopt AI tools responsibly.
  • Experience with Medicaid HCBS, personal care services, or home care programs (preferred).
  • Familiarity with EVV data and 21st Century Cures Act EVV mandates (preferred).
  • Experience presenting fraud findings to regulators, compliance teams, or law enforcement partners (preferred).
  • Exposure to AI or machine learning tools in healthcare fraud detection or payment integrity (preferred).
  • Professional certification such as CFE, AHFI, CHC, or CPC (preferred).
  • Experience with Python, R, or data visualization / business intelligence tools (preferred).

Benefits

  • Base salary range of $155,000-$165,000 per year, plus variable compensation.
  • Remote role for candidates located in the U.S. Eastern or Central time zones.
  • Competitive health plans.
  • Paid time off.
  • Company-paid holidays.
  • 401(k) retirement program with company match.
  • Access to other company-sponsored programs.
  • Benefits-eligible position.

Interested in this position?

Apply directly on the company website

Apply Now

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