RemoteLeaf Logo
Log in Sign up

Sr. Program Integrity Analyst

3 weeks 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 11

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

Similar Roles

TrueTandem

Business Systems Analyst

TrueTandem 51-250 Internet Software & Services

TrueTandem is seeking a Business Systems Analyst to support enterprise application modernization, governance, and technology strategy initiatives by translating stakeholder and technical needs into clear requirements, documentation, and analytical work products.

Anywhere Full-time Senior Business Analyst
$115k-$145k
Agile Power BI Scrum
3 hours, 58 minutes ago
Pingwind

Business Analyst

Pingwind 51-250 Internet Software & Services

PingWind is seeking a remote Business Analyst to support the federal FSA Identity and Access Management modernization project by translating stakeholder needs into Agile requirements and helping deliver prioritized features.

Anywhere Full-time Mid Level Business Analyst
$84k-$116k
Agile JIRA Scrum
3 hours, 58 minutes ago
kake

Senior Product Data Scientist

kake 1-10 Internet Software & Services

Product Data Scientist supporting a product team by analyzing user behavior, leading experimentation, and translating insights into decisions that improve the product roadmap.

Latin America Senior Product Analyst
Apache Airflow Python Snowflake SQL Statistics
4 hours, 12 minutes ago
Nortal

(1541) Microsoft Dynamics 365 F&SCM Functional Analyst

Nortal 251-1K Internet Software & Services

Nortal is seeking a Microsoft Dynamics 365 Finance & Supply Chain Management Functional Analyst to support a global implementation and stabilization initiative across multiple countries and legal entities, optimizing standard D365 functionality and reducing unnecessary customization.

Latin America Full-time Senior Business Analyst
ERP Playwright
4 hours, 13 minutes ago

You're on a roll! Sign up now to keep applying.

Sign Up

Already have an account? Log in

Used by 14,729+ remote workers