Medicaid/Medicare Program Integrity Analyst I

Overview Medicaid/Medicare Program Integrity Analyst I - REMOTE This position is responsible for assisting the Program Integrity Analyst II (PI2) and Program Integrity Supervisor with processing timely administrative actions.

In assuming this position, you will be a critical contributor to meeting CoventBridge Integrity Systems' 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. If not local, remotely from a home office.

Responsibilities/ Requirements Responsibilities:

• Enters new leads in UCM and AdvanceTrack for analysis and potential escalation to the Medicare or Medicaid teams for investigation, law enforcement payment suspensions, non-Lead DME national payment suspensions, selection of leads for administrative action, and special project leads
• Submits payment suspension activation and ad hoc requests to the MAC upon suspension approval for durable medical equipment suppliers
• Submits requests for data analysis
• Submits acknowledgment/resolution correspondence
• Updates UCM and AdvanceTrack with suspension escrow data
• Monitors revocations workload in UCM
• Compiles and maintains various documentation and other reporting requirements
• Serves as mentor and trainer to new Program Integrity staff
• Performs other projects or responsibilities as assigned by the PI Management Team

Requirements:

• Effective time management and prioritization skills
• Ability to work independently
• Ability to plan and manage multiple assignments, projects and adjust to changing priorities
• Effective communication skills
• Working knowledge of AdvanceTrack and UCM or an inventory management and reporting system required

Educational/Experience Qualifications:

• High School Diploma or G.E.D equivalent
• 1-5 years related experience

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 $60,000 to $67,000 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 Integrity Systems delivers investigative services, technology, and expertise that help healthcare and government organizations protect critical programs, strengthen oversight, and address fraud, waste, abuse, and operational risk.

CoventBridge Integrity Systems 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 characteristics and maintains a drug-free workplace.

CoventBridge Integrity Systems is committed to the full inclusion of all qualified individuals. As part of this commitment, CoventBridge Integrity Systems will ensure that persons with disabilities are provided reasonable accommodations. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact: Human Resources; 888-932-7364; [email protected].