Payment Integrity Investigator, Senior Analyst

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.

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.