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 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. 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:

• 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

• 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 $50,000 to 60,000 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 respective Fair Chance Ordinances of both Los Angeles and San Francisco, we will consider for employment qualified applicants with arrest and conviction records.

About Us:

CoventBridge Group is the global leader in full-service investigations providing Surveillance, SIU and Compliance, Claims Investigation, Counter-Fraud Programs, Desktop Investigations, Social Media, Record Retrieval, Canvasses and Vendor Management programs. The company provides top tier data privacy and security practices, deploys robust case management technology customized to clients’ needs and delivers worldwide coverage via its 1000 employees and affiliates worldwide.

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 characteristics and maintains a drug-free workplace.

CoventBridge is committed to the full inclusion of all qualified individuals. As part of this commitment, CoventBridge 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].