Payment Integrity Analyst

Job Summary

A company is looking for a Payment Integrity Analyst - Remote.

Key Responsibilities:

• Validate and investigate referrals of fraud, waste, and abuse (FWA)
• Detect fraudulent activity by beneficiaries, providers, and other parties against government contracts
• Develop and deploy effective investigative strategies and maintain accurate case information

Required Qualifications:

• 3+ years of experience in health care fraud, waste, and abuse (FWA)
• 3+ years of experience conducting comprehensive research on billing abnormalities
• Experience gathering information for and responding to subpoenas
• Demonstrated knowledge of medical terminology and coding guidelines
• Understanding of claims processing and adjudication