This position is responsible for performing provider audits to identify potential fraud, waste, abuse, or erroneous billing. The Program Integrity Analyst II will identify aberrant trends from claims data and review medical records to determine if billing patterns are justified. The Program Integrity Analyst II should be a subject matter expert as it relates to the state and federal guidelines for Program Integrity.
MINIMUM EDUCATION REQUIREMENTS
SPECIAL KNOWLEDGE AND/OR SKILLS
Virginia Premier Health Plan, Inc. is a managed care organization which began as a full-service Medicaid MCO in 1995. Partnered with VCU Medical Systems we strive to meet the needs of the underserved and vulnerable populations in Virginia by delivering quality driven, culturally sensitive and financially viable Medicare and Medicaid healthcare programs. Headquartered in Richmond, VA we also have offices in Roanoke, Tidewater and Bristol with additional satellite locations allowing us to serve over 200,000 members across eighty counties throughout Virginia.
We offer competitive salaries and a comprehensive benefits package to include excellent Medical, Dental and Vision Plans, Tuition Assistance, Infant-At-Work Program, Remote Work options and generous vacation and sick leave policies. Our culture supports an environment where employees can continuously learn and gain professional growth through various development programs, education, exciting projects and career mobility.
All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE
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