Sr. Program Integrity Analyst

HHAeXchange is the leading technology platform for home and community-based care. Founded in 2008, HHAeXchange was born out of an idea to create a fully comprehensive end-to-end homecare solution to help people who are aging or have disabilities thrive in their homes and communities. Our employees are passionate about transforming the healthcare space by building the only homecare ecosystem that fully connects patients, personal care providers, managed care organizations, and states.

The Sr Program Integrity Analyst is a key member of HHAeXchange’s growing Program Integrity function, responsible for identifying fraud, waste, and abuse patterns in Medicaid home and community-based care data and translating those findings into scalable detection capabilities embedded within the HHAeXchange platform. This role sits at the intersection of investigative analysis, product development, and customer engagement — serving as the domain expert who grounds product development in operational and regulatory reality, ensuring that detection logic is clinically sound, investigatively credible, and directly actionable by the customers who rely on it to protect public funds and program integrity.

The role works closely with product, engineering, and client-facing teams to ensure that analytical findings create measurable value for HHAeXchange customers.

To perform this job successfully, an individual must be able to perform each essential job duty satisfactorily with or without reasonable accommodation. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

This is a remote opportunity for candidates that are located within the EST or CST time zones within the United States.

Fraud Waste and Abuse Analysis and Fraud Pattern Identification

• Analyze Medicaid claims, visit, and EVV datasets to identify patterns and anomalies indicative of fraud, waste, or abuse in home and community-based care settings.
• Apply knowledge of how FWA manifests in Medicaid billing to identify suspicious patterns, including visit overlaps, impossible billing hours, upcoding, duplicate or unbundled claims, provider billing spikes, beneficiary identity issues, and EVV inconsistencies.
• Distinguish between fraud (intentional misrepresentation), waste (over utilization without intent), and abuse (improper practice), and recommend appropriate investigative or corrective responses for each category.
• Conduct proactive analysis to surface emerging fraud trends and systemic program integrity risks, not solely in response to known or referred patterns.
• Apply knowledge of the Medicaid revenue cycle to contextualize billing anomalies and assess their program integrity implications.

Product and Engineering Collaboration

• Translate analytical findings and fraud patterns into clear, precise business requirements for product and engineering teams, specifying what detection logic should catch, what data signals trigger it, and what thresholds or conditions apply.
• Contribute to the design of fraud detection dashboards, alerting systems, and investigation workflows, ensuring that tools are grounded in how investigators and compliance teams actually operate.
• Validate that detection tools and analytical models perform as intended — identifying false positives, coverage gaps, and missed risk categories as they are developed and refined.
• Serve as the subject matter expert on FWA and program integrity concepts, ensuring that detection logic embedded in the platform is operationally sound and clinically credible.

Customer and Stakeholder Engagement

• Present fraud findings and program integrity insights to state Medicaid agencies, managed care organizations, and internal stakeholders in formats that are clear, credible, and directly actionable.
• Support customers in understanding what detection findings mean for their regulatory reporting obligations, corrective action priorities, audit readiness, and program integrity outcomes.
• Advise state and payer partners on how HHAeXchange detection capabilities align with CMS Medicaid Integrity Program (MIP) standards and applicable federal program integrity…