Integrity Management Services, Inc. (IntegrityM) is an award-winning, women-owned small business specializing in assisting government and commercial clients in compliance and program integrity efforts, including the prevention and detection of fraud, waste and abuse in government programs. Results are achieved through data analytics, technology solutions, audit, investigation, and medical review.
At IntegrityM, we offer a culture of opportunity, recognition, collaboration, and supporting our community. We thrive off of these fundamental elements that make IntegrityM a great place to work. Our small, flexible workplace offers an exceptional quality of life and promotes corporate-driven sustainability. We deliver creative solutions that exceed goals and foster a dynamic, idea-driven environment that nurtures our employees’ professional development. Large company perks…Small company feel!
We are now seeking a Sr. Healthcare Fraud Data Analyst to join our team.
The essential functions of this position include:
- Participate and coordinate the identification, documentation, analysis and validation of advanced business processes, systems, and solution requirements.
- Researches, evaluates and designs components of complex solutions to problems.
- Provides expertise to support requirements of cross-functional initiatives and projects, while contributing to the development and techniques used to meet the requirements of the business unit.
- Ensures customer satisfaction by handling unique and difficult situations/projects under minimal direction in a timely and quality manner.
- Ability to resolve/recommend action on most issues.
- Handle escalated issues from customers with minimal assistance.
- Manage multiple assignments with little to no supervision.
Qualified candidates will possess the following:
- Bachelor's degree or equivalent work experience in health care fraud, waste and abuse. May hold advanced certification in work field.
- 8-10 years of work experience in the healthcare fraud environment.
- Expert knowledge of commercial and government insurance programs.
- At least 3 years' experience in Medicare, Medicaid or both.
- Expert level of understanding and application of healthcare related technologies.
- Extensive knowledge and experience with project management, research and problem resolution techniques.
- Ability to plan, develop and manage the scope of a complex project/issue with minimal direction from leadership.
- Three or more years' experience developing proactive data projects from conception to identification of investigative leads.
- Strong proven analytical ability and basic knowledge of statistics and sampling techniques.
- Strong computer skills including Microsoft Access, experience in relational data base design, extract and reporting, Excel and the Internet.
- Proven ability to work with a variety of systems, sources of data and analytic tools.
- Three or more years' experience in CMS systems such as OnePI, SAS, EBI, Business Objects and (preferably) the Unified Case Management tool.
- Strong communication and organization skills.
All candidates MUST pass a background check and drug screening prior to employment.
Integrity Management Services, Inc. (IntegrityM) is a women-owned small business specializing in assisting government healthcare organizations prevent and detect fraud and abuse in their programs. With a highly professional staff of data analysts, statisticians, medical professionals, auditors, investigators, evaluators, and regulatory analysts, IntegrityM focuses on helping ensure the integrity of healthcare program regulations and policy. Services offered by IntegrityM include:
- Data Analysis
- Regulatory Analysis
- Program Evaluations
- Program Compliance & Oversight
Commensurate with experience.