Program Integrity Analyst III (Senior PI Analyst)

Overview

Program Integrity Analyst III (Senior PI Analyst) -  REMOTE

 

The Program Integrity Analyst III performs evaluation and development of leads, complaints, and/or investigations to verify allegations of potential fraud. Recommends and/or implements appropriate administrative actions. Assists the PI Supervisor with non-managerial tasks as assigned.

 

In assuming this position, you will be a critical contributor to meeting CoventBridge Group's objective:  To provide services to our clients that exceed their expectations and contribute to improved healthcare delivery by identifying and eliminating fraud, waste and abuse.

 

This position will report directly to the Program Integrity Supervisor and will work in our Grove City, OH office, or if not local, remotely from a home office. 

 

At this time, CoventBridge is not considering candidates who require visa sponsorship, currently or in the future, including but not limited to H-1B, H-2B, E-3, TN, O-1, F-1 (OPT/CPT, or J-1 Visa Statuses.)

Responsibilities/ Requirements

 Responsibilities: 

• Performs evaluation and development of leads, complaints, and/or investigations to determine if further investigation and administrative actions are warranted. Conduct independent reviews resulting from the discovery of situations that potentially involve fraud or abuse
• Utilize basic data analysis techniques to detect aberrancies in Medicare or Medicaid claims data, and proactively seeks out and develops leads/investigations received from a variety of sources (e.g., CMS, OIG, 1-800-MEDICARE, and fraud alerts)
• Compile and maintain documentation and information related to leads, investigations, or requests for information
• Prepares, quality checks and submits external correspondence and reports, including but not limited to, overpayment letters, fraud case referrals, suspensions, rebuttals, Medicare/Medicaid findings reports, and administrative action recommendations
• Participate in onsite audits in conjunction with investigation development
• Serves as mentor/trainer to new Program Integrity staff
• Assists the PI Supervisor with matrix reviews, document reviews, or other non-management tasks
• Perform other duties as assigned by PI Supervisor or PI Manager that contributes to task order goals and objectives

 

Requirements:

• Excellent research and organization skills, prioritization, and time management skills
• Excellent verbal and written communication skills
• Ability to work independently with minimal supervision
• Ability to multi-task in a fast-paced environment
• Knowledge of Statistics, Data Analysis techniques, and PC skills are preferred

 

Educational/Experience Qualifications:

• High School Diploma or G.E.D equivalent, with preference given to those candidates who have successfully completed college or technical degree programs related to the position (e.g., Criminal Justice, Statistics, Data Analysis, etc.)
• Candidates with Certified Fraud Examiner (CFE) Certification will be given priority consideration
• At least 1 year of experience in program integrity investigation/detection or a related field that demonstrates expertise in reviewing, analyzing/developing information, and making appropriate decisions
• Sufficient experience working with CMS and CoventBridge processes and systems to perform mentorship/training of staff preferred

Benefits

• Medical, Dental, Vision plans
• Life, LTD and STD paid by the employer
• 401(k) with company match up to 4%
• Paid Time Off and company paid holidays
• Tuition assistance after 1 year of service

 

The salary range for this role is $63k - $70k annually. This is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future.  An employee’s pay position within the salary range will be based on several factors including, but not limited to, relevant education, qualifications, certifications, experience, skills, geographic location, performance, and business or organizational needs.    

 

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

 

About Us:

 

CoventBridge is an equal opportunity employer.  We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, caste, disability, veteran status, and other legally protected c