Senior Payment Integrity Investigator
Gainwell Technologies
full-time
Posted on:
Location Type: Remote
Location: Texas • United States
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Salary
💰 $64,500 - $92,200 per year
Job Level
About the role
- Conduct FWA audits and investigations, including medical record review, coding validation, and claims analysis
- Prepare high-quality written audit findings, referrals, and overpayment recommendations with clear, defensible rationale
- Communicate audit results to clients professionally and confidently
- Review claims, billing practices, and medical documentation to identify improper payments, aberrant patterns, and potential fraud schemes
- Support referrals to state agencies, OIG, MFCU, or law enforcement and assist in testimony preparation as needed
- Research applicable billing, coding, and reimbursement rules to ensure findings align with Medicaid policy
- Manage a caseload independently, ensuring accuracy, timeliness, and contractual SLA compliance
- Provide subject-matter guidance to internal teams regarding FWA trends, audit standards, and industry best practices
Requirements
- 5+ years of Healthcare FWA Audit or Investigative experience required
- Certified coder (CPC, CPMA, or equivalent) with strong knowledge of ICD-10-CM, CPT/HCPCS, and Medicaid Reimbursement Methodologies
- Experience analyzing claims, documentation, and billing patterns to determine compliance with program rules
- Strong analytical and critical-thinking skills; ability to synthesize information from multiple sources
- Professional credentials such as CFE, AHFI, or nursing licensure (RN/LPN) preferred
Benefits
- generous, flexible vacation policy
- educational assistance
- comprehensive health benefits
- 401(k) employer match
- leadership and technical development academies
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
FWA auditsmedical record reviewcoding validationclaims analysisICD-10-CMCPTHCPCSMedicaid reimbursement methodologiesbilling practicesdocumentation analysis
Soft Skills
analytical skillscritical-thinking skillscommunication skillsprofessionalismindependent managementsubject-matter guidance
Certifications
CPCCPMACFEAHFInursing licensure (RN)nursing licensure (LPN)