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Sr. Program Integrity Analyst

Hhaexchange · United States · Remote · Active · $130,000 / year · Lever

Job facts

FieldValue
CompanyHhaexchange
TitleSr. Program Integrity Analyst
Normalized title-
Department / teamOperations / Revenue Cycle Operations
LocationUnited States
Work modelRemote / Remote
Employment typeFull Time
Salary$130,000 / year
Statusactive
ATS providerLever
Posted / first seen2026-04-06 / 2026-05-29
Changed / last seen2026-05-29 / 2026-06-06

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PageWhat it containsOpen
Company jobsActive postings from Hhaexchange.Open
Company breakdownsRole, location, ATS, and work model facets for this company.Open
ATS provider jobsActive postings observed through Lever.Open
Provider filtered searchThe same provider as a filtered job collection.Open
Department jobsActive postings in Operations.Open
Work model jobsActive Remote postings.Open
Lifecycle eventsOpen, update, close, and reopen events for this posting.Open
Original postingCanonical source or apply URL captured from the ATS.Open

Linked records

CompanyHhaexchange
Source4381073e-590b-49bf-a33a-99690844b917
ATS providerLever

Description

HHAeXchange is the leading technology platform for home and community-based care. Founded in 2008, HHAeXchange was born out of an idea to create a fully comprehensive end-to-end homecare solution to help people who are aging or have disabilities thrive in their homes and communities. Our employees are passionate about transforming the healthcare space by building the only homecare ecosystem that fully connects patients, personal care providers, managed care organizations, and states. The Sr Program Integrity Analyst is a key member of HHAeXchange’s growing Program Integrity function, responsible for identifying fraud, waste, and abuse patterns in Medicaid home and community-based care data and translating those findings into scalable detection capabilities embedded within the HHAeXchange platform. This role sits at the intersection of investigative analysis, product development, and customer engagement — serving as the domain expert who grounds product development in operational and regulatory reality, ensuring that detection logic is clinically sound, investigatively credible, and directly actionable by the customers who rely on it to protect public funds and program integrity. The role works closely with product, engineering, and client-facing teams to ensure that analytical findings create measurable value for HHAeXchange customers. To perform this job successfully, an individual must be able to perform each essential job duty satisfactorily with or without reasonable accommodation. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This is a fully remote opportunity for candidates located in the EST or CST time zones within the US only. The base salary range for this US-based, full-time, and exempt position is $130,000-155,000/yr, not including variable compensation. An employee’s exact starting salary will be based on various factors including but not limited to experience, education, training, merit, location, and the ability to exemplify the HHAeXchange core values. This is a benefits-eligible position. HHAeXchange offers competitive health plans, paid time-off, company paid holidays, 401K retirement program with a Company elected match, including other company sponsored programs. HHAeXchange is an equal-opportunity employer. The Company offers employment opportunities to all applicants and employees without regard to race, color, religion, national origin, sex, sexual orientation, gender identity or expression, age, disability, medical condition, marital status, veteran status, citizenship, genetic information, hairstyles, or any other status protected by local or federal law. Essential Job Duties Fraud Waste and Abuse Analysis and Fraud Pattern Identification Analyze Medicaid claims, visit, and EVV datasets to identify patterns and anomalies indicative of fraud, waste, or abuse in home and community-based care settings. Apply knowledge of how FWA manifests in Medicaid billing to identify suspicious patterns, including visit overlaps, impossible billing hours, upcoding, duplicate or unbundled claims, provider billing spikes, beneficiary identity issues, and EVV inconsistencies. Distinguish between fraud (intentional misrepresentation), waste (overutilization without intent), and abuse (improper practice), and recommend appropriate investigative or corrective responses for each category. Conduct proactive analysis to surface emerging fraud trends and systemic program integrity risks, not solely in response to known or referred patterns. Apply knowledge of the Medicaid revenue cycle to contextualize billing anomalies and assess their program integrity implications. Product and Engineering Collaboration Translate analytical findings and fraud patterns into clear, precise business requirements for product and engineering teams, specifying what detection logic should catch, what data signals trigger it, and what thresholds or conditions apply. Contribute to the design of fraud detection dashboards, alerting systems, and investigation workflows, ensuring that tools are grounded in how investigators and compliance teams actually operate. Validate that detection tools and analytical models perform as intended — identifying false positives, coverage gaps, and missed risk categories as they are developed and refined. Serve as the subject matter expert on FWA and program integrity concepts, ensuring that detection logic embedded in the platform is operationally sound and clinically credible. Customer and Stakeholder Engagement Present fraud findings and program integrity insights to state Medicaid agencies, managed care organizations, and internal stakeholders in formats that are clear, credible, and directly actionable. Support customers in understanding what detection findings mean for their regulatory reporting obligations, corrective action priorities, audit readiness, and program integrity outcomes. Advise state and payer partners on how HHAeXchange detection capabilities align with CMS Medicaid Integrity Program (MIP) standards and applicable federal program integrity requirements. Document analytical methodologies and investigation approaches to support customer compliance reviews, regulatory audits, and reporting obligations. Contribute to customer discussions on detection strategy, helping state and MCO partners prioritize program integrity efforts based on risk exposure and data findings. Other Job Duties Other duties as assigned by supervisor or HHAeXchange leader. Travel Requirements Travel up to 10%, including overnight travel Required Education, Experience, Certifications and Skills Bachelor’s degree and a minimum of 5 years experience in healthcare fraud detection, program integrity, payment integrity, SIU investigation, or a closely related field, with substantive knowledge of how fraud, waste, and abuse manifests in healthcare billing data. Working knowledge of how Medicaid programs operate, including how providers enroll, document services, submit claims, and are reimbursed. Demonstrated ability to recognize FWA patterns in healthcare claims or billing data and distinguish between fraud, waste, and abuse in context. Strong analytical thinking and investigative problem-solving skills, including the ability to follow a data thread from anomaly to finding to recommendation. Ability to communicate complex analytical findings clearly and credibly to both technical and non-technical audiences, including engineers, compliance officers, state regulators, and executive stakeholders. Ability to work effectively in an evolving environment where capabilities and processes are actively being developed. Working familiarity with data tools sufficient to query, explore, and validate analytical outputs independently. Willingness to explore and adopt AI tools responsibly to enhance productivity and innovation in your role. Preferred Experience with Medicaid HCBS, personal care services, or home care programs. Familiarity with electronic visit verification (EVV) data and the EVV mandates under the 21st Century Cures Act. Experience presenting fraud findings to state regulators, managed care compliance teams, or legal and law enforcement partners. Exposure to AI or machine learning tools applied to healthcare fraud detection or payment integrity. Professional certifications such as: Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified in Healthcare Compliance (CHC), or Certified Professional Coder (CPC). Experience with Python, R, or data visualization / business intelligence tools.

Full job record

Job IDc0e0d2d5c124e303702d5f40b3f68f6c78ea8e60
Org ID215cfdb1-1be5-4171-9df0-de1fe1c07437
Source ID4381073e-590b-49bf-a33a-99690844b917
Board ID4381073e-590b-49bf-a33a-99690844b917
Providerlever
Provider Job Keyed890808-f943-48fc-8b2d-6cb2fa07e5bc
TitleSr. Program Integrity Analyst
Normalized Title—
Statusactive
Activeyes
Location TextUnited States
DepartmentOperations
TeamRevenue Cycle Operations
Employment TypeFull Time
Workplace Typeremote
Remote Policyremote
CountryUnited States
Region—
City—
Salary Rawsalary range for this US-based, full-time, and exempt position is $130,000-155,000/yr, not including variable compensation
Salary Min130,000
Salary Max—
Salary CurrencyUSD
Salary Periodyear
Source URLhttps://jobs.lever.co/hhaexchange/ed890808-f943-48fc-8b2d-6cb2fa07e5bc
Apply URLhttps://jobs.lever.co/hhaexchange/ed890808-f943-48fc-8b2d-6cb2fa07e5bc/apply
First Seen At2026-05-29 07:02:21Z
Last Seen At2026-06-06 20:03:04Z
Last Checked At2026-06-06 20:03:04Z
Last Changed At2026-05-29 07:02:21Z
Inactive At—
Source Posted At2026-04-06 20:53:15Z
Source Updated At—
Raw Payload Uris3://job-postings-prod-raw-590183727216/raw/provider=lever/board=hhaexchange/date=2026-06-06/2026-06-06T20-03-03-037Z-071f64cd5206ae346bf19c42443f65bb653f1fbebba53c98eef699b1b1d472ac.json
Event Fields
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  "active_status": "active"
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Extensions
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Native Structured
{
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    {
      "text": "Essential Job Duties",
      "content": "<p style=\"text-align: justify; margin: 0in; font-size: 12pt; font-family: 'Times New Roman', serif;\"><strong><span style=\"font-size: 10.0pt; font-family: Arial, sans-serif; color: black;\">Fraud Waste and Abuse Analysis and Fraud Pattern Identification</span></strong></p>\n<ul style=\"margin-bottom: 0in; margin-top: 0px;\">\n<li style=\"text-align: justify; margin: 0in 0in 0in 0px; font-size: 12pt; font-family: 'Times New Roman', serif;\"><span style=\"font-size: 10.0pt; font-family: Arial, sans-serif; color: black;\">Analyze Medicaid claims, visit, and EVV datasets to identify patterns and anomalies indicative of fraud, waste, or abuse in home and community-based care settings.</span></li>\n<li style=\"text-align: justify; margin: 0in 0in 0in 0px; font-size: 12pt; font-family: 'Times New Roman', serif;\"><span style=\"font-size: 10.0pt; font-family: Arial, sans-serif; color: black;\">Apply knowledge of how FWA manifests in Medicaid billing to identify suspicious patterns, including visit overlaps, impossible billing hours, upcoding, duplicate or unbundled claims, provider billing spikes, beneficiary identity issues, and EVV inconsistencies.</span></li>\n<li style=\"text-align: justify; margin: 0in 0in 0in 0px; font-size: 12pt; font-family: 'Times New Roman', serif;\"><span style=\"font-size: 10.0pt; font-family: Arial, sans-serif; color: black;\">Distinguish between fraud (intentional misrepresentation), waste (overutilization without intent), and abuse (improper practice), and recommend appropriate investigative or corrective responses for each category.</span></li>\n<li style=\"text-align: justify; margin: 0in 0in 0in 0px; font-size: 12pt; font-family: 'Times New Roman', serif;\"><span style=\"font-size: 10.0pt; font-family: Arial, sans-serif; color: black;\">Conduct proactive analysis to surface emerging fraud trends and systemic program integrity risks, not solely in response to known or referred patterns.</span></li>\n<li style=\"text-align: justify; margin: 0in 0in 0in 0px; font-size: 12pt; font-family: 'Times New Roman', serif;\"><span style=\"font-size: 10.0pt; font-family: Arial, sans-serif; color: black;\">Apply knowledge of the Medicaid revenue cycle to contextualize billing anomalies and assess their program integrity implications.</span></li>\n\n<p style=\"text-align: justify; 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font-family: Arial, sans-serif; color: black;\">Contribute to the design of fraud detection dashboards, alerting systems, and investigation workflows, ensuring that tools are grounded in how investigators and compliance teams actually operate.</span></li>\n<li style=\"text-align: justify; margin: 0in 0in 0in 0px; font-size: 12pt; font-family: 'Times New Roman', serif;\"><span style=\"font-size: 10.0pt; font-family: Arial, sans-serif; color: black;\">Validate that detection tools and analytical models perform as intended — identifying false positives, coverage gaps, and missed risk categories as they are developed and refined.</span></li>\n<li style=\"text-align: justify; margin: 0in 0in 0in 0px; font-size: 12pt; font-family: 'Times New Roman', serif;\"><span style=\"font-size: 10.0pt; font-family: Arial, sans-serif; color: black;\">Serve as the subject matter expert on FWA and program integrity concepts, ensuring that detection logic embedded in the platform is operationally sound and clinically credible.</span></li>\n\n<p style=\"text-align: justify; margin: 0in 0in 0in 0.5in; font-size: 12pt; font-family: 'Times New Roman', serif;\">&nbsp;</p>\n<p style=\"text-align: justify; margin: 0in; font-size: 12pt; font-family: 'Times New Roman', serif;\"><strong><span style=\"font-size: 10.0pt; font-family: Arial, sans-serif; color: black;\">Customer and Stakeholder Engagement</span></strong></p>\n<ul style=\"margin-bottom: 0in; margin-top: 0px;\">\n<li style=\"text-align: justify; margin: 0in 0in 0in 0px; font-size: 12pt; font-family: 'Times New Roman', serif;\"><span style=\"font-size: 10.0pt; font-family: Arial, sans-serif; color: black;\">Present fraud findings and program integrity insights to state Medicaid agencies, managed care organizations, and internal stakeholders in formats that are clear, credible, and directly actionable.</span></li>\n<li style=\"text-align: justify; margin: 0in 0in 0in 0px; font-size: 12pt; font-family: 'Times New Roman', serif;\"><span style=\"font-size: 10.0pt; font-family: Arial, sans-serif; color: black;\">Support customers in understanding what detection findings mean for their regulatory reporting obligations, corrective action priorities, audit readiness, and program integrity outcomes.</span></li>\n<li style=\"text-align: justify; margin: 0in 0in 0in 0px; font-size: 12pt; font-family: 'Times New Roman', serif;\"><span style=\"font-size: 10.0pt; font-family: Arial, sans-serif; color: black;\">Advise state and payer partners on how HHAeXchange detection capabilities align with CMS Medicaid Integrity Program (MIP) standards and applicable federal program integrity requirements.</span></li>\n<li style=\"text-align: justify; margin: 0in 0in 0in 0px; font-size: 12pt; font-family: 'Times New Roman', serif;\"><span style=\"font-size: 10.0pt; font-family: Arial, sans-serif; color: black;\">Document analytical methodologies and investigation approaches to support customer compliance reviews, regulatory audits, and reporting obligations.</span></li>\n<li style=\"text-align: justify; margin: 0in 0in 0in 0px; font-size: 12pt; font-family: 'Times New Roman', serif;\"><span style=\"font-size: 10.0pt; font-family: Arial, sans-serif; color: black;\">Contribute to customer discussions on detection strategy, helping state and MCO partners prioritize program integrity efforts based on risk exposure and data findings.</span></li>\n</ul></ul></ul>"
    },
    {
      "text": "Other Job Duties",
      "content": "<div>\n\n<li>Other duties as assigned by supervisor or HHAeXchange leader.</li>\n\n</div>"
    },
    {
      "text": "Travel Requirements",
      "content": "\n<li>Travel up to 10%, including overnight travel</li>\n"
    },
    {
      "text": "Required Education, Experience, Certifications and Skills",
      "content": "<ul style=\"margin-bottom: 8pt; margin-top: 0px;\">\n<li style=\"margin: 0in 0in 8pt 0px; line-height: 106%; font-size: 12pt; font-family: 'Times New Roman', serif;\"><span style=\"font-size: 10.0pt; line-height: 106%; font-family: Arial, sans-serif; color: black;\">Bachelor’s degree and a minimum of 5 years experience in healthcare fraud detection, program integrity, payment integrity, SIU investigation, or a closely related field, with substantive knowledge of how fraud, waste, and abuse manifests in healthcare billing data.</span></li>\n<li style=\"margin: 0in 0in 8pt 0px; line-height: 106%; font-size: 12pt; font-family: 'Times New Roman', serif;\"><span style=\"font-size: 10.0pt; line-height: 106%; font-family: Arial, sans-serif; color: black;\">Working knowledge of how Medicaid programs operate, including how providers enroll, document services, submit claims, and are reimbursed.</span></li>\n<li style=\"margin: 0in 0in 8pt 0px; line-height: 106%; font-size: 12pt; font-family: 'Times New Roman', serif;\"><span style=\"font-size: 10.0pt; line-height: 106%; font-family: Arial, sans-serif; color: black;\">Demonstrated ability to recognize FWA patterns in healthcare claims or billing data and distinguish between fraud, waste, and abuse in context.</span></li>\n<li style=\"margin: 0in 0in 8pt 0px; line-height: 106%; font-size: 12pt; font-family: 'Times New Roman', serif;\"><span style=\"font-size: 10.0pt; line-height: 106%; font-family: Arial, sans-serif; color: black;\">Strong analytical thinking and investigative problem-solving skills, including the ability to follow a data thread from anomaly to finding to recommendation.</span></li>\n<li style=\"margin: 0in 0in 8pt 0px; line-height: 106%; font-size: 12pt; font-family: 'Times New Roman', serif;\"><span style=\"font-size: 10.0pt; line-height: 106%; font-family: Arial, sans-serif; color: black;\">Ability to communicate complex analytical findings clearly and credibly to both technical and non-technical audiences, including engineers, compliance officers, state regulators, and executive stakeholders.</span></li>\n<li style=\"margin: 0in 0in 8pt 0px; line-height: 106%; font-size: 12pt; font-family: 'Times New Roman', serif;\"><span style=\"font-size: 10.0pt; line-height: 106%; font-family: Arial, sans-serif; color: black;\">Ability to work effectively in an evolving environment where capabilities and processes are actively being developed.</span></li>\n<li style=\"margin: 0in 0in 8pt 0px; line-height: 106%; font-size: 12pt; font-family: 'Times New Roman', serif;\"><span style=\"font-size: 10.0pt; line-height: 106%; font-family: Arial, sans-serif; color: black;\">Working familiarity with data tools sufficient to query, explore, and validate analytical outputs independently.</span></li>\n<li style=\"margin: 0in 0in 8pt 0px; line-height: 106%; font-size: 12pt; font-family: 'Times New Roman', serif;\"><span style=\"font-size: 10.0pt; line-height: 106%; font-family: Arial, sans-serif; color: black;\">Willingness to explore and adopt AI tools responsibly to enhance productivity and innovation in your role.</span></li>\n\n<p style=\"margin: 0in 0in 8pt; line-height: 106%; font-size: 12pt; font-family: 'Times New Roman', serif;\"><strong><span style=\"font-size: 10.0pt; line-height: 106%; font-family: Arial, sans-serif; color: black;\">Preferred</span></strong></p>\n<ul style=\"margin-bottom: 8pt; margin-top: 0px;\">\n<li style=\"margin: 0in 0in 8pt 0px; line-height: 106%; font-size: 12pt; font-family: 'Times New Roman', serif;\"><span style=\"font-size: 10.0pt; line-height: 106%; font-family: Arial, sans-serif; color: black;\">Experience with Medicaid HCBS, personal care services, or home care programs.</span></li>\n<li style=\"margin: 0in 0in 8pt 0px; line-height: 106%; font-size: 12pt; font-family: 'Times New Roman', serif;\"><span style=\"font-size: 10.0pt; line-height: 106%; font-family: Arial, sans-serif; color: black;\">Familiarity with electronic visit verification (EVV) data and the EVV mandates under the 21st Century Cures Act.</span></li>\n<li style=\"margin: 0in 0in 8pt 0px; line-height: 106%; font-size: 12pt; font-family: 'Times New Roman', serif;\"><span style=\"font-size: 10.0pt; line-height: 106%; font-family: Arial, sans-serif; color: black;\">Experience presenting fraud findings to state regulators, managed care compliance teams, or legal and law enforcement partners.</span></li>\n<li style=\"margin: 0in 0in 8pt 0px; line-height: 106%; font-size: 12pt; font-family: 'Times New Roman', serif;\"><span style=\"font-size: 10.0pt; line-height: 106%; font-family: Arial, sans-serif; color: black;\">Exposure to AI or machine learning tools applied to healthcare fraud detection or payment integrity.</span></li>\n<li style=\"margin: 0in 0in 8pt 0px; line-height: 106%; font-size: 12pt; font-family: 'Times New Roman', serif;\"><span style=\"font-size: 10.0pt; line-height: 106%; font-family: Arial, sans-serif; color: black;\">Professional certifications such as: Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified in Healthcare Compliance (CHC), or Certified Professional Coder (CPC).</span></li>\n<li style=\"margin: 0in 0in 8pt 0px; line-height: 106%; font-size: 12pt; font-family: 'Times New Roman', serif;\"><span style=\"font-size: 10.0pt; line-height: 106%; font-family: Arial, sans-serif; color: black;\">Experience with Python, R, or data visualization / business intelligence tools.</span></li>\n\n<p style=\"margin: 0in; font-size: 12pt; font-family: 'Times New Roman', serif;\">&nbsp;</p></ul></ul>"
    }
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