Program Integrity Analyst III

🔥 0 minutes ago

Apply Now

Find Similar Remote Jobs

Receive Emails For Remote Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Qlarant

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1973

🏛️ Government

⚕️ Healthcare Insurance

Government • Healthcare Insurance • Insurance & Financial Services

Qlarant is a US-based services and technology firm specializing in healthcare program integrity, offering quality improvement, fraud, waste & abuse (FWA) detection and investigative services, and advanced data analytics and predictive modeling tools (the RIViR® Risk Solution Suite) for government agencies, health plans, and related sectors. The company also operates initiatives like the Qlarant Foundation and Qlarant Capital to fund grants and early-stage startups, and provides pharmacy, drug pricing, and transportation-focused solutions.

📋 Description

• Works with a team of internal and external professionals as a subject matter expert • Participates in planning and execution of team projects, assisting with setting strategic goals • Implements processes and uses necessary tools to enhance project execution and drive consistent performance improvements • Conducts research of program areas/topics defined by management; participates in internal and external focus groups • Utilizes experience to identify appropriate reports, rules, and regulations for drafting vulnerability reports • Meets regularly with teams to discuss current and future projects; advises teams and management • Contributes to final written product presented to stakeholders; proofreads written products of team members • Serves as a productive member of external and internal teams to ensure all deadlines for deliverables are met • Briefs management on projects, including completion timelines and potential difficulties • Provides clinical input as a Subject Matter Expert for program integrity and program vulnerability • Identifies and mitigates risks proactively, implementing strategies to ensure continuity of project execution • Participates in project reporting and performance analysis, ensuring accuracy of project data

🎯 Requirements

• Bachelor's Degree required • 5 - 7 years required; 8 - 11 years preferred • RN preferred • Experience in Medicaid coding, billing, auditing, and compliance from a state or federal perspective • Medicaid program integrity auditing experience is preferred • Experience locating and interpreting publicly available Medicaid information to identify relevant potential program vulnerabilities