Healthcare Program Integrity Consultant

🔥 10 minutes ago

🌵 Arizona, Florida, +23 more states – Remote

🌵 Arizona – Remote 🐊 Florida – Remote 🌽 Illinois – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote 🦬 Montana – Remote 🌾 Nebraska – Remote 🎰 Nevada – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🦀 Maryland – Remote 🍂 Massachusetts – Remote 🚗 Michigan – Remote 🎸 Mississippi – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote 🌴 South Carolina – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⚔️ Virginia – Remote ☕ Washington – Remote ⛰️ West Virginia – Remote 🧀 Wisconsin – Remote

💵 $150k - $175k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💻 Solutions Engineer

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Commence

WebsiteLinkedInAll Job Openings

501 - 1000 employees

🏥 Healthcare

🏛️ Government

🤖 Artificial Intelligence

Healthcare • Government • Artificial Intelligence

Commence is a healthcare data and technology company that delivers data-centered solutions to make health data more accessible, discoverable, and interoperable. The company pairs clinical expertise with AI-driven data transformation and a technology platform to address fraud, waste & abuse, independent dispute resolution, peer and independent reviews, quality improvement, and patient advocacy. Commence serves federal health agencies (CMS, VA, Defense Health Agency), state & local government programs, and commercial health customers, focusing on improving outcomes, accuracy, and program integrity.

📋 Description

• Play a significant role in the growth and success of Commence in the commercial payer market • Serve as a trusted authority on healthcare fraud, waste and abuse, payment integrity operations, and Special Investigative Unit (SIU) functions • Bridge operational knowledge with technology to assist prospective customers • Provide domain support during customer onboarding and implementation

🎯 Requirements

• Bachelor's degree in healthcare administration, public health, business, or a related field • Minimum of 5 years of hands-on experience in healthcare fraud, waste and abuse, payment integrity, or SIU operations within a commercial health plan, managed care organization, or health IT/analytics company serving commercial payers • Deep knowledge of commercial payer payment integrity operations including pre-payment clinical review, post-payment auditing and recovery, provider fraud patterns, billing scheme identification, claims analysis, and SIU case management • Demonstrated ability to translate operational payment integrity knowledge into practical technology use cases and client-facing solution narratives, not just describe how the payer world works, but show how technology changes it • Strong written and verbal communication skills with the ability to engage credibly with SIU analysts, payment integrity directors, compliance officers, and C-suite payer stakeholders • Ability to travel within the United States on a monthly basis

🏖️ Benefits

• N/A