Program Integrity Contract Lead (Healthcare)

Location: Remote nationwide within the United States; occasional travel to hirify.global offices for training or meetings may be required. U.S. citizenship is required, and candidates currently living in Puerto Rico cannot be hired.

Salary: $94,900–$130,500 per year, plus eligibility for a bonus incentive plan.

Company

hirify.global is a U.S. healthcare company providing insurance and healthcare services to Medicare, Medicaid, military, individual, and family customers.

What you will do

• Translate VA Community Care Network contract requirements into business processes, workflows, controls, procedures, and implementation plans.
• Identify operational gaps and develop corrective actions, standard operating procedures, job aids, workflows, and training materials.
• Establish contract monitoring frameworks covering performance, service levels, key performance indicators, deliverables, milestones, and operational commitments.
• Apply Lean, Six Sigma, root cause analysis, and other process improvement methods to strengthen operational and contract performance.
• Prepare Contract Data Requirements List reports, maintain the Program Integrity documentation library, analyze data findings, and brief stakeholders and leadership.
• Collaborate with compliance, data, technology, and operational stakeholders on business and financial models and risk mitigation strategies.

Requirements

• 5+ years of Program Integrity and/or Payment Integrity experience.
• 2+ years of project management experience, ideally implementing large contracts.
• One required anti-fraud qualification: RN/BSN, CPC, CCS, CCDS, CHC, HCAFA, AHFI, CFE, or JD.
• Experience with claims adjudication, systems and reporting, healthcare applications, contract interpretation, data analysis, and root cause analysis.
• Strong communication, presentation, problem-solving, analytical, and prioritization skills, including communication with senior and executive leadership.
• U.S. citizenship and successful approval for a government security clearance through NBIS are required.

Nice to have

• BA in Business, Healthcare Administration, or Operations Management.
• Lean Six Sigma and/or project management certification or experience.
• Experience with VA, Medicare, or TRICARE government programs.
• Experience leading programs, technical implementations, workflow design, or business process optimization.

Culture & Benefits

• Remote work from a dedicated space with sufficient internet connectivity and privacy for PHI and HIPAA information.
• Medical, dental, and vision benefits.
• 401(k) retirement savings plan, paid time off, holidays, and paid parental and caregiver leave.
• Short- and long-term disability coverage and life insurance.
• 40-hour scheduled work week with occasional travel for training or meetings.