California Licensed Program Integrity Specialist

Job Summary

A company is looking for a Program Integrity Specialist II (Defined Term).

Key Responsibilities

• Conducts medium- to high-complexity investigations into alleged fraud, waste, and abuse
• Assists with the administration of medium- to high-complexity Program Integrity activities
• Supports the execution and oversight of moderate- to high-complexity privacy-related compliance activities

Required Qualifications, Training, and Education

• Bachelor's degree in Healthcare Administration, Public Health Administration, Criminal Justice, Finance, or a related field
• A minimum of three years of program integrity, auditing, quality improvement, or compliance-related experience in the healthcare industry
• Knowledge of HIPAA regulations and commitment to maintaining data privacy and security
• Experience working in a managed care or healthcare environment
• Knowledge of Medi-Cal and Medicare Advantage programs and related regulations