Gainwell Technologies logo
Gainwell Technologies

Gainwell Technologies is an award-winning digital health technology company that supports the administration of healthcare and human services programs. In past

Payment Integrity Investigator, Senior Analyst

Location

United States

Posted

89 days ago

Salary

$64.5K - $92.2K / year

Seniority

Senior

No structured requirement data.

Job Description

Payment Integrity Investigator, Senior Analyst

Gainwell Technologies

Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You’ll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have comprehensive leadership and technical development academies to help build your skills and capabilities. Job Summary We are seeking an experienced healthcare fraud, waste, and abuse (FWA) investigator and certified coder to support our Program Integrity Audit Unit. The Payment Integrity Investigator, Senior Analyst role conducts professional audits and investigations of Medicaid claims, identifies overpayments and potential fraud, and prepares clear, defensible audit findings for clients. The ideal candidate has strong investigative skills, excellent written documentation abilities, and confidence communicating audit results directly with clients and providers. Your role in our mission - · 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. Basic Qualifications - · 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. What you should expect in this role - Fully Remote Opportunity - Opportunities to travel through your work (0-10%) Note - Video cameras must be used during all interviews, as well as during the initial week of orientation. The deadline to submit applications for this posting is June 30, 2026. The pay range for this position is $64,500.00 - $92,200.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities. We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings. Gainwell Technologies is committed to a diverse, equitable, and inclusive workplace. We are proud to be an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We celebrate diversity and are dedicated to creating an inclusive environment for all employees.

Job 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.
  • Fully Remote Opportunity.
  • Opportunities to travel through your work (0-10%).

Benefits

  • Generous, flexible vacation policy.
  • 401(k) employer match.
  • Comprehensive health benefits.
  • Educational assistance.
  • Leadership and technical development academies to help build your skills and capabilities.

Related Categories

Related Job Pages

More Analyst Jobs

SteerBridge logo

Senior Logistics Analyst

SteerBridge

Your Mission. Our Passion.

Analyst89 days ago
Full TimeRemoteTeam 51-200Since 2011H1B No Sponsor

• Deliver innovative, mission-focused solutions to the U.S. Government and private sector • Leverage expertise in federal acquisition, digital transformation, and emerging technologies • Cultivate exceptional talent and create career pathways for veterans and military spouses

Maryland
$95K - $110K / year
Job Closed
Analyst89 days ago
Full TimeRemoteTeam 51-200Since 2011H1B No Sponsor

• Deliver innovative, mission-focused solutions to the U.S. Government and private sector • Leverage expertise in federal acquisition, digital transformation, and emerging technologies • Accelerate operational effectiveness and drive measurable mission success • Collaborate with veterans and professionals to advance technology

Maryland
$85K - $100K / year
Job Closed
Precision for Medicine logo

Financial Analyst - FP&A

Precision for Medicine

Precision Medicine Group is an Equal Opportunity Employer. Employment decisions are made without regard to race, color, age, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status or other characteristics protected by law. If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact Precision Medicine Group at QuestionForHR@precisionmedicinegrp.com. It has come to our attention that some individuals or organizations are reaching out to job seekers and posing as potential employers presenting enticing employment offers. We want to emphasize that these offers are not associated with our company and may be fraudulent in nature. Please note that our organization will not extend a job offer without prior communication with our recruiting team, hiring managers and a formal interview process.

Analyst89 days ago
Full TimeRemoteTeam 51-200

Role Description We’re expanding across Mexico, Brazil, Argentina, Colombia, Chile, and Peru and seeking a Financial Analyst – FP&A to join our growing team! Job Overview: - Metrics & Finance Reporting: - Experience using PowerBI and building Dashboard and Reports is a must. - Managing complex financial models including reporting holistic project profitability and being able to present findings to leadership. - The ability to deep dive into departmental and regional reporting. - Documenting processes, recognizing areas of process improvement, and implementing streamlined procedures. - Supporting the finance teams with analysis for revenues/sales and costs based on contracts and prepare analysis over billing roles/rates and client and project profitability, regional and departmental reporting, as well as tracking all CRO metrics. - Monthly Reporting: - Performing monthly variance analysis with forecast to actuals and recommending actions to management. - Assisting with creation of financial presentation for executive management. - Preparing the financial reporting portions of monthly financial reporting packages. - Ad-hoc analysis and collaboration with other teams. - Preparation of monthly, quarterly, and annual budget forecasting cycles and working with department managers to collect inputs and perform analytical reviews and of financial dashboards and reporting of key performance measurements using accurate and quality data. Qualifications - Bachelor’s degree with concentration in accounting or finance and 3+ years practical experience. - Advanced EXPERIENCE with MS PowerBI, CoPilot (or other AI), PowerPoint, and Excel (including experience of working with XLookups, Pivot tables, and data consolidations). Requirements - Excellent financial modelling capabilities, ability to handle large datasets and draw a roadmap to systematically designing the flow of financial information. - Ability to handle multiple projects at a time, focused on the details while finding creative ways to take on big picture challenges. - With your analytics and financial acuity, you'll liaise between the Finance team with the functional areas it supports. - Resolve issues related to forecasting, planning, and business profitability, and help translate analyses into easy-to-understand presentations. - Understand the value of the finance & accounting function working symbiotically to support a growing company and provide your opinion and point of view. - Self‑motivation and proactive work habits, with the ability to take initiative without waiting for direction. - Strong ownership and accountability, consistently following through on tasks, deadlines, and deliverables. - Ability to work independently while contributing effectively in a team environment, maintaining open communication and collaboration across finance, operations, and regional partners. - Comfort working across different time zones, including managing deliverables and communication with geographically distributed teams. - Reliable prioritization and follow‑through in a fast‑paced environment with shifting demands. - Professional curiosity and willingness to learn, continuously improving processes and deepening technical expertise. - Clear and timely communication regarding task status, risks, and dependencies. - Strong sense of urgency and adherence to deadlines, especially during financial close cycles. Company Description Precision Medicine Group is an Equal Opportunity Employer. Employment decisions are made without regard to race, color, age, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status or other characteristics protected by law. If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact Precision Medicine Group at QuestionForHR@precisionmedicinegrp.com. It has come to our attention that some individuals or organizations are reaching out to job seekers and posing as potential employers presenting enticing employment offers. We want to emphasize that these offers are not associated with our company and may be fraudulent in nature. Please note that our organization will not extend a job offer without prior communication with our recruiting team, hiring managers and a formal interview process.

Remote
Job Closed
Precision Medicine Group logo

Financial Analyst - FP&A

Precision Medicine Group

Precision Medicine Group delivers specialty services that help its life science clients navigate healthcare challenges. The company entered its 10th year of suc

Analyst89 days ago

Role Description We’re expanding across Mexico, Brazil, Argentina, Colombia, Chile, and Peru and seeking a Financial Analyst – FP&A to join our growing team! - Metrics & Finance Reporting: - Experience using PowerBI and building Dashboard and Reports is a must. - Managing complex financial models including reporting holistic project profitability and being able to present findings to leadership. - The ability to deep dive into departmental and regional reporting. - Documenting processes, recognizing areas of process improvement, and implementing streamlined procedures. - Supporting the finance teams with analysis for revenues/sales and costs based on contracts and prepare analysis over billing roles/rates and client and project profitability, regional and departmental reporting, as well as tracking all CRO metrics. - Monthly Reporting: - Performing monthly variance analysis with forecast to actuals and recommending actions to management. - Assisting with creation of financial presentation for executive management. - Preparing the financial reporting portions of monthly financial reporting packages. - Ad-hoc analysis and collaboration with other teams. - Preparation of monthly, quarterly, and annual budget forecasting cycles and working with department managers to collect inputs and perform analytical reviews and of financial dashboards and reporting of key performance measurements using accurate and quality data. Qualifications - Bachelor’s degree with concentration in accounting or finance and 3+ years practical experience. - Advanced EXPERIENCE with MS PowerBI, CoPilot (or other AI), PowerPoint, and Excel (including experience of working with XLookups, Pivot tables, and data consolidations). Requirements - Excellent financial modelling capabilities, ability to handle large datasets and draw a roadmap to systematically designing the flow of financial information. - Ability to handle multiple projects at a time, focused on the details while finding creative ways to take on big picture challenges. - With your analytics and financial acuity, you'll liaise between the Finance team with the functional areas it supports. - Resolve issues related to forecasting, planning, and business profitability, and help translate analyses into easy-to-understand presentations. - Understand the value of the finance & accounting function working symbiotically to support a growing company and provide your opinion and point of view. Benefits - Self‑motivation and proactive work habits, with the ability to take initiative without waiting for direction. - Strong ownership and accountability, consistently following through on tasks, deadlines, and deliverables. - Ability to work independently while contributing effectively in a team environment, maintaining open communication and collaboration across finance, operations, and regional partners. - Comfort working across different time zones, including managing deliverables and communication with geographically distributed teams. - Reliable prioritization and follow‑through in a fast‑paced environment with shifting demands. - Professional curiosity and willingness to learn, continuously improving processes and deepening technical expertise. - Clear and timely communication regarding task status, risks, and dependencies. - Strong sense of urgency and adherence to deadlines, especially during financial close cycles.

Americas
Job Closed