Program Integrity Specialist - ILIFE

Description

Job Purpose: The Program Integrity Specialist is responsible for analyzing processes, incident reporting, communications, and referrals from other sources for program integrity measures and triggers. The position manages and/or facilitates referrals for suspected fraud, misuse, waste, and abuse within privately and publicly funded program rules. The Program Integrity Specialist interfaces with clients, government, and law enforcement agencies to ensure program integrity within the Fiscal, IRIS, and/or client payroll processes. This position also supports projects based on business needs and caseload in queue which may include but is not limited to data collection, data analysis, reporting data, and creating project materials as needed.
Essential Job Functions:
(Reasonable accommodations may be made to enable individuals with disabilities to perform these essential functions.)
• Identifies, analyzes, and investigates potential fraud, waste, or abuse through pre- and post-pay claims reviews, documenting findings and preparing supporting reports for referrals.
• Collects, reviews, and analyzes relevant documents, statements, interviews, and financial records related to fraud allegations.
• Maintains a database of fraud case information, documenting case activity, fund allocation, and conducting follow-up actions per departmental guidelines.
• Reconciles documents related to payroll, including court orders, budgets, and employee/employer records.
• Establishes and maintains relationships with funders, law enforcement, external agencies, and customers to support fraud investigations.
• Serves as the subject matter expert in iLIFE, providing expertise in judicial or court system hearings related to Fiscal, IRIS, and client payroll processes.
• Analyzes and audits program integrity forms, processes, and reporting, ensuring compliance and identifying trends for further review and corrective action.
• Monitors work queues and internal reporting for HIPAA breaches, identifying potential violations, and documenting necessary reporting steps to ensure compliance with privacy and security regulations.
• Other duties as assigned

Qualifications

Required Education, Experience, Certifications, Licensure and Credentials: (Where appropriate, education and/or experience may be substituted)

Minimum Required Education: Associate degree or higher in business/accounting preferred, or an equivalent combination of training and experience which will provide the necessary knowledge, skills and abilities.

Minimum Required Experience:  2 years professional experience in any of the essential job functions listed above
Required License – Certification – Registration:
Issued By Governing Body (if applicable):
Travel Type: None

Knowledge – Skills – Abilities:

• High degree of integrity
• Strong organizational skills and prioritization skills for multiple investigations, projects, and responsibilities
• Exceptional attention to detail
• Experience conducting audits and/or investigations in a professional setting
• Understanding and application of programmatic policies, procedures, work instructions and regulations
• Comfortable working with our funders, law enforcement agencies, external program agencies and customers
• Experience preparing/presenting oral and written reports
• Ability to work mostly independently but also as a team
• Ability to mediate and deescalate disputes
• Ability to problem solve and think critically in unique situations
• Mathematical Reasoning
• Accountable & dependable
• Proficient in Microsoft Suite and SharePoint

Physical Requirements, Visual Acuity, and Work Conditions:

Physical Requirements: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time.

Visual Acuity: The worker is required to have close visual acuity to perform an activity such as: preparing and analyzing data and figures; transcribing; viewing a computer terminal.

Working Conditions: None: The worker is not substantially exposed to adverse environmental conditions.