Certified Program Integrity Analyst

Job Summary

A company is looking for a Program Integrity Controls Analyst III (Certification Required).

Key Responsibilities

• Lead implementation of Program Integrity requirements for Medicaid/Medicare
• Monitor and audit Grievance and Appeals for fraud trends and compliance
• Draft and submit responses to state and federal audits and inquiries

Required Qualifications, Training, and Education

• Bachelor's Degree in Compliance, Healthcare, or a Legal field or equivalent experience
• Minimum of four (4) years of experience in a compliance or legal field
• Experience in internal and external auditing, risk management, and performance improvement
• Previous experience in financial calculations
• Experience with Marketplace, Medicaid, and/or Medicare products is preferred