Sr. Program Integrity Analyst (Healthcare)

TL;DR

Sr. Program Integrity Analyst (Healthcare): Identifying fraud, waste, and abuse patterns in Medicaid data to develop scalable detection capabilities within the platform with an accent on investigative analysis and regulatory compliance. Focus on translating analytical findings into precise business requirements for product development and managing stakeholder engagement with state agencies.

Location: Remote (United States)

Company

hirify.global is a leading technology platform providing end-to-end homecare solutions for patients, providers, and state agencies.

What you will do

• Analyze Medicaid claims and EVV datasets to identify Fraud, Waste, and Abuse (FWA) patterns and anomalies.
• Translate investigative findings into technical business requirements for product and engineering teams to build detection logic.
• Design and validate fraud detection dashboards, alerting systems, and investigation workflows.
• Present program integrity insights and findings to state Medicaid agencies and managed care organizations.
• Advise partners on alignment with CMS Medicaid Integrity Program (MIP) standards and federal requirements.

Requirements

• Bachelor's degree and 5+ years of experience in healthcare fraud detection, program integrity, or SIU investigation.
• Substantive knowledge of Medicaid program operations, including provider enrollment, billing, and reimbursement.
• Ability to communicate complex analytical findings to both technical and non-technical audiences.
• Experience querying and exploring data independently across fragmented architectures.
• Must be based in the United States.

Nice to have

• Experience with Medicaid HCBS, personal care services, or EVV mandates under the 21st Century Cures Act.
• Proficiency in Python, R, or BI tools for data visualization.
• Professional certifications such as CFE, AHFI, CHC, or CPC.
• Exposure to AI or machine learning tools applied to healthcare fraud detection.

Culture & Benefits

• Fully remote work environment.
• Opportunity to transform the healthcare space by building a comprehensive homecare ecosystem.
• Collaborative environment working across product, engineering, and client-facing teams.
• Focus on protecting public funds and improving home and community-based care.