Program Integrity Analyst

Position:
Sr. Program Integrity Analyst

Company:
HHAeXchange

Compensation:
$155,000-165,000/yr

Location:
United States (Remote)

Employment type:
Full Time

Work Arrangement:
Remote

Short Summary:
The Sr Program Integrity Analyst is responsible for identifying fraud, waste, and abuse patterns in Medicaid home and community-based care data and translating those findings into scalable detection capabilities within the HHAeXchange platform. This role involves investigative analysis, product development, and customer engagement.

Responsibilities:
- Analyze Medicaid claims, visit, and EVV datasets to identify patterns indicative of fraud, waste, or abuse.
- Apply knowledge of FWA in Medicaid billing to identify suspicious patterns.
- Conduct proactive analysis to surface emerging fraud trends.
- Translate analytical findings into business requirements for product and engineering teams.
- Present fraud findings and program integrity insights to stakeholders.
- Document analytical methodologies to support customer compliance reviews.
- Travel up to 10%, including overnight travel.

Requirement:
- Bachelor’s degree and a minimum of 5 years experience in healthcare fraud detection or a closely related field.
- Strong analytical thinking and investigative problem-solving skills.
- Ability to communicate complex findings clearly to technical and non-technical audiences.
- Familiarity with data tools sufficient to query and validate analytical outputs.
- Preferred experience with Medicaid HCBS, personal care services, or home care programs.

Benefits:
- Competitive health plans
- Paid time-off
- Company paid holidays
- 401K retirement program with a company elected match
- Other company-sponsored programs