Healthcare Program Integrity Solutions Consultant

🕒 July 27

🌵 Arizona, Florida, +22 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 ⛰️ West Virginia – Remote 🧀 Wisconsin – Remote

💵 $150k - $175k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💻 Solutions Engineer

👻 Ghost score 31%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New 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

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

• Serve as a trusted authority on healthcare fraud, waste and abuse, payment integrity operations, and Special Investigative Unit functions • Support sales, customer success, product, and engineering teams with payment integrity domain expertise • Bridge commercial payer operational knowledge with technology and demonstrate how the Commence platform maps to FWA and payment integrity workflows • Provide domain support during customer onboarding and implementation • Serve as the primary internal and external expert on commercial health plan payment integrity operations • Develop and maintain payment integrity documentation, use cases, and enablement materials • Partner with product management and engineering on product design and roadmap decisions • Monitor commercial payer fraud trends, payment integrity best practices, HIPAA compliance requirements, and regulatory changes • Identify new product opportunities based on payment integrity trends and evolving commercial health plan needs • Represent Commence's payment integrity expertise at industry forums, payer-facing events, and conferences • Partner with sales throughout the commercial sales cycle from initial discovery through close • Help qualify and prioritize opportunities based on operational fit and business value • Conduct structured discovery conversations about payment integrity operations, SIU structure, review processes, and investigation challenges • Lead or participate in product demonstrations • Support RFP and RFI responses requiring payment integrity domain knowledge • Travel within the United States on a monthly basis

🎯 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 • Ability to translate operational payment integrity knowledge into practical technology use cases and client-facing solution narratives • Strong written and verbal communication skills • 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 • Prior experience in a client-facing, solutions consulting, or vendor-facing role within a healthcare technology, analytics, or payment integrity company • Experience working with commercial payer procurement, vendor evaluation, and technology adoption cycles • Familiarity with fraud detection platforms, payment integrity solutions, case management tools, or clinical review technologies • Certified Fraud Examiner (CFE), Certified in Healthcare Compliance (CHC), or similar credential • Remote candidates must be located in AZ, AR, DE, FL, GA, IL, IN, KS, KY, MA, MD, MI, MS, MO, MT, NC, NE, NV, NY, OH, OK, PA, SC, TN, TX, VA, DC, WI, or WV

🏖️ Benefits

• Remote work option • Reasonable accommodations for individuals with disabilities • Equal employment opportunity